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A Distinction Without a Difference: Death with Dignity and Suicide

Kate Bresee

On November 1st, 2014, Brittany Maynard, a 29-year-old woman who had been diagnosed with terminal brain cancer, ended her life under the sanction of Oregon’s Death with Dignity (DWD) Act. The general notion of the individual’s “right to die” that was reflected in Maynard’s decision has been a growing controversy in recent years as Oregon, Washington, Vermont, and (technically) Montana have rendered physician-assisted suicide legally permissible.

I’d prefer not to comment on the moral value of physician-assisted suicide itself, but I would like to assess some of the underlying ideas that are often at play in the current debate. Specifically, what I keep hearing from people in favor of the individual’s right to end his or her own life is that Brittany Maynard, and individuals like her, did not commit suicide (despite the fact that it is legally referred to as physician-assisted suicide). The Gazette originally posted the story of Maynard’s death under the headline: “Woman, 29, with terminal brain cancer commits suicide.” Many people were unhappy with this characterization of Maynard’s death, responding “She did not commit suicide. She ended her life. She wanted to live. There is a huge difference!” and “I would change your headline.” The Gazette did in fact change its headline, noting that “The decision by Brittany Maynard to end her own life, when announced in recent weeks, brought debate from both sides of the issue. We have changed the headline…It now reads: ‘Brittany Maynard dies at 29.’”[1]

These exchanges left me puzzled. I can see why someone might claim that life imminently ending in severe pain is not worth living. And I can maybe see why an individual ought to be able to end his or her life when in this position. And I can maybe see why, in the same vein, physicians ought to be permitted to have some involvement in this decision for the sake of public safety and like concerns. But what I cannot see is how this isn’t suicide.

Let us revisit the comment from mysterious internet user #1: “She did not commit suicide. She ended her life. She wanted to live. There is a huge difference!” So, the difference between suicide and ending one’s life is that, in the latter case, one desires to live, but (the claim seems to go) there is some contingent, supervening circumstance (in Maynard’s case, terminal brain cancer) that renders life no longer worth living, despite some perduring desire to live. This is different from suicide because people who commit suicide aren’t facing some supervening circumstance; they, unlike those who choose death with dignity, do not ultimately desire to live. Indeed, people in Maynard’s situation would give anything to take the place of those who commit suicide. After all, they are perfectly healthy and live unthreatened by tragic medical diagnoses like terminal brain cancer.

But I find this claim appalling. The distinction between suicide and “death with dignity” only works if we’re presupposing an account of suicide that is, at best, archaic and, at worst, brutally insensitive to the plight of all individuals who have contemplated, attempted, or committed suicide.

By that I mean: Since it’s not 1750, I think we (should) know that people who contemplate/commit suicide are not sitting there with a perfectly enjoyable life that they’re just not interested in as if they were passing up the dessert of the day. Instead, people who commit suicide seem to be in exactly the same position as Maynard, namely, they would want to live if their lives weren’t devastated by some tragic circumstance. Maynard would want to live if she didn’t have terminal brain cancer. In the same way, suicidal individuals would want to live if their circumstances were different: if, for example, they weren’t suffering from chronic, severe, and either seemingly or conclusively unmanageable depression; if they hadn’t suffered terrible and utterly inhuman physical, emotional, and/or sexual abuse; if they weren’t living with severe addictions from which there seemed to be no escape; if their spouses hadn’t left them. The list could go on indefinitely.

My point is that what we want to say about those who choose death with dignity is exactly what is true about persons who contemplate/commit suicide, namely, that they may very well have, in some way, a desire to live, but that that desire cannot in fact be met in light of some supervening circumstance. To say that death with dignity is somehow categorically different from suicide is to reduce suicide and, more specifically, the psychological problems that accompany it, to some sort of voluntary choice, to some sort of, perhaps unpleasant, but ultimately self-inflicted (and therefore self-indulgent) condition. It doesn’t seem to me that anyone can reasonably claim that DWD individuals’ decisions to end their lives does not constitute suicide without also adopting a naïve, if not brutally unfeeling conception of suicide and mental illness.

Just like Maynard, the suicidal person sees her life as not worth living. Just like Maynard, the suicidal person would want to live if it weren’t for some supervening circumstance (whether or not that person is in fact aware that his or her circumstance is contingent, that life could potentially be otherwise). In the same way that a DWD individual might say “If only I weren’t suffering from terminal cancer…”, the suicidal individual might say “If only I weren’t irrevocably depressed…”, “If only these kids weren’t bullying me…”, “If only I weren’t haunted by sexual abuse…”. That these problems are “psychological” does not mean that they are somehow more within the individual’s control than Maynard’s own tragic circumstance. To say otherwise is implicitly to adopt a theory of human psychology that, above and beyond its scientific inadequacies, is deeply inhuman. Again: “Psychological” does not mean “easily managed,” “trivial,” and it certainly does not mean “In your control.”[2]

DWD individuals and suicidal individuals alike are facing horrible, tragic circumstances that lead them to believe that life is not worth living, that one would be better off ending it now. So, in an effort to be respectful to those who face heartbreaking circumstances like Maynard’s, let us not be disrespectful to those victims of suicide who also face agonizing circumstances.

 

Notes:

[1] This statement as well as the comments referenced above are located on The Gazettes Facebook page (https://www.facebook.com/springsgazette/posts/869116626446687).

[2] At the same time, I wouldn’t want to deny that there are obviously effective ways to treat mental illness. However, this does not retract from the fact that DWD individuals and suicidal individuals are in a similar psychological states; namely, they have a sense that their situation is hopeless.