Chapter – 8
SUICIDE
To be, or not to be; that is the question:
Whether ‘It is nobler in the mind to suffer.
The slings and arrows of outrageous fortune,
Or to take arms against a sea of trouble
And, by opposing, end them. To die, to sleep-
No more, and by a sleep to say we end.
The heartache and the thousand natural shocks.
That flesh is heir to – tis a consummation
Devoutedly to be wished. To die, to sleep.
-William Shakespeare. “Hemlet”
There is only one serious philosophical of problem, and that is suicide
-Albert Camus, French novelist
The thought of suicide us a great consolation: by means of it one gets successfully through many bad nights.
– Friedrich Nietzche
Suicide (Latin – suicidium, from Sui Cadere, “to kill oneself) is the act of causing one’s own death. Suicide is often committed out of despair, the cause of which is frequently attributed to a mental disorder, alcoholism, or drug abuse, health and relationship problems, and financial difficulties. Common methods include: hanging, pesticide poisoning and firearms. It is estimated that 10 to 20 million people worldwide attempt suicide every year. Around 1 million of them succeed.
Attempted suicide is self-injury with a desire to end one’s life that does not result in death. Assisted suicide is when one individual helps another bring about their own death indirectly via providing the means to the end. This is in contrast to euthanasia, where another person takes a more active role in bringing about a person’s death.
Risk Factors For Suicide
Factors that affect the risk of suicide include psychiatric disorders, drug misuse, psychological states, cultural, family and social situations, and genetics. Mental illness and drug abuse frequently co-exist. Other risk factors include having previous attempted suicide, the ready availability of a means to commit the act (example – pesticides, firearms), a family history of suicide, or the presence of traumatic brain injury. For example, suicide rates have been found to be greater in households with firearms than those without them. Social-economic factors such as unemployment, poverty, and discrimination may trigger suicidal thoughts. Genetics appears to account for between 38% and 50% of suicidal behaviors. Only 15-40% of people leave suicide note.
Rational Suicide
Rational suicide is the reasoned taking of one’s own life, although some feel that suicide is never rational. The act of taking one’s life for the benefit of others is known as altruistic suicide. An example of this is an elder ending his or her life to leave greater amount of food for the younger people in the community. Suicide in some Eskimo cultures has been seen as an act of respect, courage or wisdom.
Some commit suicide as an act of political protest against injustice. Some suicide bombers are motivated by a desire to obtain martyrdoms (Kamikaze missions). Mass suicides are often performed under social pressure where members give up autonomy to a leader. In extenuating situations where continuing to live would be intolerable, some people use suicide as a means of escape. Some inmates of Nazi concentration camps are known to have killed themselves by deliberately touching the electric fences.
Methods
The leading method of suicide varies between countries. The leading methods in different regions include hanging, pesticide poisoning, and firearms. These differences are believed to be in part due to availability of different methods. Hanging is the most common method in most countries, accounting for 53% of the male suicides and 39% of the female suicides. Worldwide 30% of suicide are from ingestion of pesticide. Males die three to four times more often by means of suicide than do females, although females attempt suicide four times more often.
Prevention
Reducing access to certain methods such as firearms or toxins and pesticides reduces risk. Treatment of drug and alcohol addiction, depression, and those who have attempted suicide in the past may also be effective. In young adults who have recently thought about suicide, cognitive behavior therapy (a form of psychotherapy) appears to improve outcomes. Poverty reduction measures may be able to decrease suicide rates. Although suicide prevention crisis hot lines are common, there is little scientific evidence to support or refute their effectiveness.
Religious and Philosophical Thoughts on Suicide
Suicide has been a focus of religious and philosophical thoughts both in the East and in the West, since the sixth century B.C.
Hinduism
Hinduism accepts a man’s right to end one’s life, through non-violent practice of fasting to death. Gandhi used this tactic against the British effectively during India’s struggle for independence. According to scholar Benjamin Walker, the author of Hindu World, “Suicide was once very commonly practiced in India by all classes of people. Those who took their lives were not regarded as having committed sin, but on the contrary as having performed a meritorious act, and the record of their deed was often preserved in stone or metal…. Suicide by starvation was regarded as particularly meritorious by both Hindus and Jains.
Another method of suicide entailed going on endless pilgrimage, being constantly on the road, from one holy place to another, till one died of starvation and exhaustion. The reasons quoted in the ancient texts for committing suicide were many: old age, disease, incapacity and were oppressed with the purposelessness of living.”
Jainism
Jainism is one of the most ancient of Indian religions. Mahavira (467BCE) is regarded as its historical founder. The Jains are strict believers of non-violence. The Jain must never kill or sacrifice or harm any life even an insect. The only life he may take his own. Jainism approves of suicide, especially by slow starvation towards the end of life; a jain will often transfer his worldly responsibilities and wealth to his children and starves himself to death. Even today, some Jains, in India, die this way. The practice of non-violent fasting to death by Jains is termed Santhava.
Buddhism
A central tenet of Buddhism is captured in the word mujo meaning impermanence. Life is impermanence. Life is impermanence and full of suffering (dukha). According to mujo, cherry blossoms will fade, summer days will pass, golden autumn leaves will fall and blanket of snow will melt with morning sun light. So, too, will life fade to death. For Buddhists, since the first precept is to refrain from destruction of life (like the Jains), including one’s self, suicide is seen as a negative act. However, unlike Christianity, Buddhism does not condemn suicide. Buddhist traditions help to explain the acceptance of suicide in Japan. Under certain conditions Japanese people even glorify the act of suicide like; hara-kiri, Kamikaze acts. The Buddhists like the Hindus, also believe in reincarnation. The prospect of worldly life after death may make it easier for the Hindus and the Buddhists to treat death as just another phase of existence.
Ancient Greeks and Romans
In the Greek world each philosophical school had its own positive on suicide. Pythagoreans opposed it, but the Epicureans and the stoics welcome it. Greek history is studded with famous suicides, both historical and semi-legendary. The reasons behind these suicides varied: Isocrates and Demothenes out of remorse, Democritus and Speusippus in order to avoid the decrepitude of old age and Sappho for love. Zeno, Diogenes and Epicurus committed philosophical suicide to show their scorn for life. Epicureans teach that one should commit suicide without fuss when life becomes intolerable.
Plato and Aristotle, the two giants of Greek Philosophy and thought, disagreed on suicide. Plato was generally against it except three exceptions: (1) condemnation by the state, (2) painful and incurable illness and (3) miseries of fate, which might cover a broad range of situations from poverty to shame. His student Aristotle, considered suicide counters to virtue and an act of cowardice in face of responsibilities. His work exerted tremendous influence on medieval philosophy through St. Aquinas and Averrois.
There was no legal or religious prohibition of suicide for free men in Rome. For obvious economic reasons suicide was forbidden among slaves and soldiers. Roman history offers many examples of famous suicides including Cicero, and Cato. Seneca justified suicide in the old age. Stoic emperor Marcus Aurelius (121-180 A.D) recommended suicide if one is unable to lead the life he desires (Minois).
Judaism
The Old Testament offers a strictly neutral report of several voluntary deaths. After King Saul had lost a battle with the Philistines, he asked his armor-bearer to kill him and he refused. So “Saul took his own sword, and fell upon it.” (1-Sam 31.4). In A. D. 73, after a prolonged resistance to roman attack, 960-strong Jewish community at Masada collectively committed suicide. Among the Ten Commandments of Mosaic law obviously prohibits killing (Thou shalt not kill). However, it does not specify whether that prohibition applies also to taking one’s own life. Suicide is sometimes acceptable in Jewish law. Most authorities hold that it is not permissible to hasten death to avoid pain if one is dying, but the Talmnd is somewhat unclear on the matter. Thus the later Christian condemnation of suicide did not come from the Old Testament.
Christianity
In the New Testament, there is no direct discussion of suicide. Was Jesus’s death a suicide? John quotes Jesus as saying “I lay my life for the sheep.” No one takes it from me, but I lay it down myself” (John 10:15 and 10:18). Jesus knew what waited him when he entered Jerusalem. The first generation of Christians willingly gave themselves over to martyrdoms (suffering death for faith). The example of Christ was followed by many willing martyrs, to the point that the church became concerned.
St. Augustine (354-430 A.D), the greatest of the Latin Church Fathers, in his monumental work “The City of God” considered suicide a sin and argued against it. The Roman Catholic Church adopted St. Augustine’s views and made suicide a sin, and prohibited it. Moralists and poets threw the weight of their talents onto the balance. Dante in Canto 13 of Inferno reserved a special place for suicide in the seventh circle of hell. Canon law, (12th Century) refused Christian burial to the excommunicated, to heretics, and to those who committed suicide. Civil laws added its vigor to those of Canon laws (religious laws). In many countries in Europe the properties of the persons who committed suicide were also confiscated by the Church/or the State.
Eastern orthodoxy, on the other hand, has never made any absolute statement about people who commit suicide. Orthodox Christians leave the fate of suicide victims up to God and avoid making judgments (Minois).
Islam
Muslim teachings on suicide closely parallels Jewish and Roman Catholic thoughts. Islam views suicide as one of the greatest sins. A verse in Quran states; “And do not kill yourselves, surely God is most Merciful to you: – Quran, Sura 4 (An-Nisa), ayat29 Most Muslim scholars and clerics consider suicide forbidden, including suicide bombing.
Evolution of Attitude Toward Suicide
Around 15th century, the attitude towards suicide began to change. John Donne, an English poet, preacher and the Chaplain to the King of England wrote “Biathanatos” in 1610. In it he presented Biblical examples of Jesus, Samson and Saul and argued that suicide might not be a grave sin. During the enlightenment traditional religious attitudes toward suicide were questioned. David Hume denied that suicide was a crime. In his 17701 Essays on Suicide and Immortality of the Soul he rhetorically asked, “Why should I prolong a miserable existence, because of some frivolous advantage which the public may receive from me?” The Time of London, in 1786 initiated a spirited debate on the motion. Is suicide an act of courage?”
In Europe, by 19th century, the act of suicide had shifted from being viewed as caused by sin to being caused by insanity. By 1879, English law began to distinguish between suicide and homicide although suicide still resulted in forfeiture of estate. By mid 20th century, suicide had become legal in much of the western world.
In most Western countries, suicide is no longer a crime. Most of Muslim majority nations label it a criminal offense.
Euthanasia
Euthanasia (from Greek – eu “weu” or good, thantos – ‘death’) or good death, refers to the practice of intentionally ending life in order to relieve pain and suffering. The word “euthanasia” was first used in a medical context by Francis Bacon in the 17th century, to refer to an easy, painless, happy death.
Euthanasia can be divided into passive and active. Passive euthanasia entails the withholding of common treatments, such as antibiotics or respirator (breathing mechanism necessary for the continuance of life). Active euthanasia entails the use of lethal substance (poison) to kill the person.
History of Euthanasia
Euthanasia was practiced in Ancient Greece and Rome. Hamlock, a poison was employed by the Greeks as a means of hastening death. Socrates died from drinking hemlock. Euthanasia was supported by Socrates, Plato and Seneca the elder (Roman) in the ancient world. Hippocrates, the Greek physician appears to have spoken against the practice, writing – “I will not prescribe a deadly drug to please someone, nor give advice that may cause death.” This has been incorporated as a part of “Hippocratic oath” modern physicians take upon graduation from medical school.
Euthanasia was strongly opposed in the Judeo – Christian tradition. Thomas Aquinas and many other Christian theologians and philosophers opposed it. However English theologian and clergy John Donne, wrote in favor of it. In the mid-1800, the use of morphine to treat “the pain of death” was recommended by John Warren (1848). The Voluntary Euthanasia Legalization Society was founded in Great Britain in 1935 and in 1938 in America. In United States Robert Ingersoll argued for euthanasia, stating in 1894 that where someone is suffering from a terminal illness, such as terminal cancer, they should have a right to end their pain through suicide.
Eugenics
Eugenics (from Greek eu, meaning “good/well”, and – genes, meaning born) is the belief and practice of improving the genetic quality of human population. It is a social philosophy advocating the improvement of human genetic traits through the promotion of higher reproduction of people with desired traits, and reduced reproduction of people with less desired traits.
Francis Galton (1822-1911), English scientist, cousin of Charles Darwin, believed that desirable traits were hereditary based on biographical studies. In 1883, one year after Darwin’s death, Galton gave his research a name: “eugenics”.
Throughout its recent history, eugenics has remained a controversial concept. As a social movement, eugenic reached its greatest popularity in the early decades of 20th century. Many Western countries enacted various eugenic policies and programs. Some of the methods involved identifying individuals and families including poor, mentally ill, mentally retarded, homosexual and racial groups.
Compulsory sterilization, forced abortion, euthanasia and genocide (by Nazis) were carried out to eliminate these individuals and groups. Eugenics became an academic discipline at many colleges and universities. At its peak of popularity, eugenics was supported by a variety of prominent people, including Winston Churchill, George Bernard Sahw, John Maynard Keynes, Margaret Sanger, Theodore Roosevelt, and Nobel laureate American scientist Linus Pauling. It’s most infamous proponent and practitioner was, however Adolf Hitler and his Nazis. They killed more than 3 million so called “undesirable people,” including Jews to make their Aryan race purer.
Modern Euthanasia Movement
Killing of large number of innocent and disable children and undesirable adults by the Nazis, in the name of mercy killing, gave euthanasia a bad odor from which it has not yet recovered. Advances in medicine and changes in society during the 1950s and 1960s made people think once more about euthanasia.
Elisabeth Kubler Ross’s book “On Death Dying” 1969, became a best seller (in America), and host of similar books and articles followed. In 1980, journalist, Derek Humphrey, founded the Hemlock society. The Hemlock Society’s purpose was to help people attain peaceful death by – “providing a climate of public opinion which is tolerant of the right of people who are terminally ill to end their lives in a planned manner.” There is now, a strong movement for euthanasia and physician – assisted suicide. Philosophers, ethicists, medical and legal experts and some politicians are paying attention to these issues.
Some governments around the world have legalized voluntary euthanasia. In the Netherlands, Belgium, Luxenburg and four states in America (Oregon, Washington State, Montana and Vermont) physician – assisted suicide is already legal. In 2009 study in the United Kingdom showed a 64% support for assisted dying in cases where a patient has an incurable and painful disease.
Now, there are multiple organizations around the world that educate people on assisted suicide. Some of them are: Compassion and Choice, Death With Dignity National Center, Dignitas, Euthanasia Research and Guidance Organization (ERGO), Final Exit Network, World Federation of Right to Die Societies and many more.
Physician – Assisted Death
Physician – assisted death is a controversial topic all over the world. Assisted suicide may be a new question for lawyers, ethicists and policy-makers but for doctors it goes back to antiquity. The Hippocratic Oath, taken by all doctors during their graduation ceremony, specifically forbids doctors to give patient fatal dose of medicine, even if requested. When Hadrin, a Roman emperor, asked his doctor to help him commit suicide, the doctor in distress, killed himself. However, later on, in the first century, it became more acceptable for doctors to help patients to end their lives. That tradition till continues all over the world. Doctors have always knowingly given patients overdose of medicine like morphine to alleviate pain and in the process patients have died. Studies show that physicians assist terminally ill to die, everyday and in every country, even though it is illegal to do so in most countries.
Pros and Cons
Advocates of physician – assisted suicide believe that people have the right to control – and to choose to end their own lives. The right to ‘life’, “liberty” and “pursuit of happiness” is mentioned in the American Declaration of Independence, 1776. Other argue from a “quality of life” prospective: when a person’s life is no longer worth living, either because of extreme pain or because he or she can no longer do the things that have made her/his life meaningful. Still others believe it is permissible only when a person is nearly brain – dead and shows no possibility of recovery. Medical advances have made this scenario all too common. Patients in vegetative states or brain dead are being kept alive unnecessarily by medical life-support system.
Opponents of the right to die argue from a variety of positions. Some believe that killing is always wrong – “Though shalt not kill” – others citing the Hippocratic Oath, say that doctors in particular are professionally bound always to side with life, never death. Some worry about the abuses: Can depressed people with terminal illnesses be trusted to act in their best interests? There is also the “Slippery-Slope” argument. This argument encompasses the apprehension that once physician-assisted suicide is initiated for the terminally ill, it will progress to others vulnerable (disable) groups. However, recent studies from the Netherlands and the State of Oregon (USA) do not support the “Slippery Slope” argument. The evidence shows that legalization of physician –assisted suicide actually decreased the prevalence of involuntary euthanasia.
Some organizations opposed to assisted suicides are: United States Conference of Catholic Bishops, Euthanasia Prevention Coalition and Care Not Killing. The most important reasons for requesting assistance with suicide among patients were desire to control the circumstances of death, a desire to die at home, the belief that continuing to live was pointless and being ready to die. In a nurses study depression, lack of social support and concern about being a financial drain were found to be relatively unimportant.
Conclusion
In his illuminating book “History of Suicide”, George Minois, addresses a wide range of question drawn from theology, law, literature, science and medicine. He concludes with comment on the most recent turn on this long and complex history – the emotional debate over euthanasia, assisted suicide and the right to die. He writes in the Epiloque : “Voluntary death continues to disturb us. Hamlet’s question – “To be or not to be” is ceaselessly reborn from its ashes. The humane sciences and medicine both search for an explanation of a behavior that bewilders us but also intrigues us. Suicide inspires horror, but it remains the supreme solution to life’s problems. It is within the reach of all, and no law, no power in the world, has proven strongly enough to prohibit it.”