One Too Many image

One Too Many

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Medical science is making incredible advances. Disease after disease is being eradicated or at least rendered curable, and as our Paralympians have indisputably demonstrated, even catastrophic injury is no longer an automatic death sentence. As the diseases that lead to death are eradicated or mitigated, however, one cause of death is steadily climbing the league table.

Douglas Adams, with characteristic prescience, foresaw what this would be as long ago as 1980. “After cures had been found for all the major diseases, and instant repair systems had been invented for all physical injuries and disablements,” he wrote in an episode of The Hitchhiker’s Guide to the Galaxy, “the only doctors still in business were the psychiatrists - simply because no one had discovered a cure for the universe as a whole.”
 
Deaths from disease or disability might be falling, but it was sobering to learn yesterday that the global suicide rate is on the increase.
 
Yesterday was World Suicide Prevention Day, and the British Government marked it by unveiling a new £1.5m suicide prevention strategy. Reporting on the launch, The Guardian quoted care services minister Norman Lamb as saying:

One death to suicide is one too many – we want to make suicide prevention everyone’s business.
 
Over the last 10 years there has been real progress in reducing the suicide rate, but it is still the case that someone takes their own life every two hours in England.
 
We want to reduce suicides…

 
These comments are in line with the World Health Organisation’s Publication Public Health Action For The Prevention Of Suicide which states that “suicidal behaviours are a major public health problem” (p. 7) and that “suicide prevention is a collective responsibility, and must be spearheaded by governments and civil society throughout the world.” (p. 20)
 
What they’re not so clearly in line with, however, is Mr Lamb’s own position on assisted suicide, which he was asked about while promoting the suicide prevention strategy on Radio 4’s Today programme:

In these circumstances, where there is someone who is facing a terminal illness, there is a case for a debate. My personal view is that there is a case for reform.

 
Yes, you read that right – less than two minutes after saying “One suicide is a suicide too many”, he said that in certain circumstances suicide might be such a desirable option that it should be legal for someone to help you carry it out.
 
If that sounds like some kind of Orwellian double-think, well, that’s two very prescient writers I’ve referenced today. Orwell’s only mistake was in thinking that it would take an oppressive regime to engender double-think – today we do it all the time, and call it rationalism.
 
That someone can hold two such opposite views on the subject without noticing any conflict is due in part to a perceived category-difference between physical and mental illness. I imagine that, if pushed, Norman Lamb would say that those who seek assisted suicide have something genuinely physically wrong with them that cannot be cured, whereas those who seek to take their lives due to depression or because they can’t cope with their life-circumstances just need help to adjust their perception of reality or their circumstances. In other words, one is right to consider death as the only escape from his or her circumstances, but the other is wrong; one should be helped to die, the other helped to live.
 
Why should that be the case? Why is it reasonable for someone with a physical disease to want to end it all but not for someone with a mental or emotional one? Proponents of assisted suicide like to play the ‘pain’ card at this point. Knowing that none of us wants to see our fellow human beings in physical pain, they appeal to our compassionate natures, asking ‘isn’t it wrong to condemn a person to years of physical agony if they wish to escape that?’ Yet mention the UK’s outstanding palliative care provision and you soon find that the physical pain actually isn’t really the root issue; dignity is.
 
And there we find the source of the perceived distinction between suicide and assisted suicide. From suicide notes and the testimony of suicide survivors, we know that many who take their own lives do so because they believe there is no other option. Their families would be better off without them; they can’t face the shame of people discovering the truth about them; life is just too hopeless; they simply don’t have the strength to go on. Those of us outside their heads and circumstances can identify that these are not true statements and seek to help them correct the untruths. When someone terminally ill says they want to commit suicide because their life has become ‘dull, miserable, demeaning, undignified and intolerable’ as Locked-in Syndrome sufferer Tony Nicklinson put it, we are not sufficiently convinced of the essential dignity of the human being to enable us to counter this agonised cry. Lots of people find life dull, miserable, demeaning and intolerable, but we tell them that’s just the way life is. The WHO and the Government are going to work hard to make sure those people don’t resort to suicide as a solution to their misery, but no-one’s promising that everyone can be happy and fulfilled all the time. Throw in the word ‘undignified’, though, and that’s a different story. If you are unable to make what you consider to be a valid contribution to the world, if you are dependent on others to provide for your needs and take care of your most basic bodily functions, if your body is limiting the interaction you want to have with the world, and if you are able to express this lucidly and without coercion, our conception of freedom suggests that you ought to be able to choose death over that life.
 
It is a fine, fine line, and an issue which has troubled and divided philosophers – which circumstances do we accept as valid criteria for suicide? Can a person ever be said to be in his right mind if he is choosing death over life? Is it ever right to knowingly allow someone to commit suicide? Is it ever acceptable to help someone commit suicide? Is it ever acceptable to overrule someone’s freedom of choice and prevent him from committing suicide?
 
I am very pleased to hear that the Government is committing time and money to researching the issues surrounding suicide, and even more pleased that money and support will go to organisations working to identify those at risk of suicide and help them to find a way out of their pain and into life. I sincerely hope, though, that they will also think to include assisted suicide in their research, rather than treating it as an entirely separate question, because it is not. Our understandings of what it is to be human, and what it means to have dignity and value underpin both questions, and we would do well to pay this foundation some serious attention.

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