An essay by Julie Johnson entitled - How to save a life
On three separate occasions, Oliver told his minister, Philip, that he was seriously considering suicide and thought it unlikely that he would be able to resist the desire indefinitely. When Philip asked if he had chosen a method, Oliver replied that he had been planning to use carbon monoxide poisoning from an internal combustion engine; but in order to avoid the possibility that a neighbour, hearing the engine running, might intervene before the process was complete, he now intended also to take an overdose of a drug which he had obtained regularly on a repeat prescription.
Philip wondered if he should tell Oliver’s GP about these conversations, in order to secure his help in preventing Oliver from committing suicide.
As a Christian priest, Philip will have no doubt that suicide is ethically wrong. In this he follows a long tradition of theological teaching. In the Old Testament, God’s command “Thou shalt not kill” is taken as forbidding self-destruction, or suicide, especially as it does not add “thy neighbour” as it does when it forbids “false witness”. God is the giver of life. He gives, and He takes away (Job 1:21). God is the only one who is to decide when and how a person should die. “My times are in your hands” (Psalm 31:15). Suicide, the taking of one’s own life, is ungodly because it rejects God’s gift of life. No man or woman should presume to take God’s authority upon themselves to end his or her own life. This was further developed as an idea by St Thomas Aquinas in that we have a duty to God because God has given us life as a gift and in taking our lives we violate his right to determine the duration of our earthly existence. We have “usus” (possession) over our bodies but God retains “dominium” (dominion or authority). This view expresses a deontological argument. Both Aquinas and Locke also stated that we are God’s property and so suicide is wrong to God and akin to theft or destruction of property. [1]
In the Middle Ages, the law and popular practice allowed the desecration of the corpse along with the confiscation of their property and the refusal of a Christian burial.[2] Indeed suicide was regarded as a crime under English law until 1961. As far as the Church of England was concerned a Christian burial was not allowed for someone who had committed suicide under canon 37 and 38, although alternative services were permitted and by 1959 a report from the Board for Social Responsibility showed attitudes were changing and “Canon 38 appears to be honoured more in the breach than in the observance”[3]. However, it wasn’t until 2017, at the General Synod, that full funeral rites for suicides were officially accepted[4]. So, Oliver does not have the right to commit suicide. It is not his own life which he wants to end but the life that God had given him. He has no deontological right to kill himself.
This is not just the theological view but can also reflect atheists’ views on the “sanctity of life”. Human life is inherently valuable and precious, demanding respect from others and respect for oneself. Suicide is therefore wrong because it violates the inherent value of human life.[5] Following these arguments Philip has the obligation to do whatever he can to prevent Oliver’s suicide.
On the other hand, it is possible to argue that individuals possess the right to suicide. This argument depends on the person who wants to commit suicide being “of sound mind”. The Stoics, for example, maintained that “whenever the means to living a naturally flourishing life are not available to us, suicide may be justified”.[6] Seneca, a Stoic, killed himself and Cicero himself defended suicide as a moral virtue if “he sees in prospect a majority of the contrary things”.[7]
This is not suggesting that suicide is rational or prudent. But moral philosophers have maintained it is the right of an individual to take their own lives. It has even been called a “liberty right”. According to Schopenhauer[8] suicide violates no moral duties. It has also been called a “claim right” in that no one has the right to stop suicide from being committed.[9] This involves the principle of autonomy which has been described as “an obligation to respect the decision-making capacities of autonomous person by not limiting their liberty to effect their choices[10]. Beauchamp goes on to describe this decision-making capacity as an “ability to grasp, appreciate the significance of, form relevant intentions and not be controlled by either internal or external forces that the person cannot resist.” Partially this could apply to Philip as he formed relevant intentions by saving up a prescription drug and is intending to take an overdose. He has also considered the possibility of a neighbour intervening “before the process was complete”, so he is worried that this might be “an external force which he cannot resist.”
So far, the consequences of Philip’s action have not been considered. Suicide has been called the unkindest action. Therefore, another way to argue against suicide is how far it violates any moral duties there are towards others. It can be regarded as harm to “specific others”, such as family and friends. The consequences of Philip’s intended act could lead to economic and psychological effects not just on Philip’s family but also on his friends, his neighbours (who might have stopped his attempt to commit suicide in the garage) who might have felt they could have supported him better and it could affect the whole congregation. Philip’s suicide could have consequences for Oliver as minister as the congregation might blame him in some way. Various forms of guilt are quite common such as that arising from the belief that in some way they have contributed to the person’s suicide or they have failed to recognise the anguish of the suicidal person or that they have failed in some way to prevent the act itself. Even if Philip has no family and it appears from the case study that he does not, he is a member of society and presumably a member of the congregation. Oliver has the duty to show Philip the consequences of his proposed action and how it may play out on others. The harm caused by the consequences of his action on others has to be balanced out by the harm to the would-be suicide by continuing to live a painful or difficult life, perhaps to live with depression.
Obviously, mental capacity and the principle of autonomy are closely related and it is surely morally wrong to allow an individual, without decision making capacity, to take his own life. If the lack of capacity is temporary, the person might decide against suicide when the capacity is regained. In Oliver’s case, however, he states that he was seriously considering suicide and thought he would be unable to resist the desire indefinitely, so it does not appear to be a temporary idea. He has been to see Philip on previous occasions. Philip now has to judge how far Oliver is serious in his intentions, how far he is able to make an “autonomous” decision and what course of action he should take.
Independence and personal freedom are important freedoms that society must aim to preserve.[11] This utilitarian argument was used by philosophers such as John Stuart Mill to maintain that after an initial attempt to find the cause, any attempt to prevent suicide could not be justified. However, there was little understanding or effective treatment for mental illness which might explain Mill’s Utilitarian philosophy which appears to take the principle of personal freedom to extremes.
Mental illness is now known to be a factor in many suicides. [12] Depression is the single most common diagnosis in people who have died from suicide[13]. If Oliver does not do all he can to help Philip, he could deprive him of the opportunity of treatment which may make him feel less suicidal. Also for some people a suicide attempt is a high-risk strategy for altering their situation, “a cry for help”. This appears to fit in with the fact that Philip has been to see Oliver before about his suicidal thoughts. The cry for help model is one of ambivalence: the parts of the patient’s psyche that wants to live and the parts that wish to die may be present in different proportions at different times. [14] Perhaps death is not the purpose of the suicide attempt. This, therefore provides moral justification for what is termed “paternalistic” short term suicide prevention measures. Although Oliver may not be clinical psychiatrist, as an experienced minister he should be in a position to explore Philip’s reasons for the suicidal feelings, which could be financial, psychological, depression, loneliness, poor physical health, feeling of abandonment by God, poor self-worth and attempt to strengthen that part of his “psyche” which wants to survive. Oliver needs to remind Philip of God’s love for him as an individual and to reassure him that although the world may seem to be a very dark place, it is God’s world. We do not have any background in the case study which could help to suggest why Philip feels the urge to commit suicide. But on a human level Oliver has a duty to try and find out the causes of Philip’s distress and to try to help to alleviate them.
But how far should Oliver intervene in Philip’s case? Should he tell Philip’s GP about the conversations? Firstly, whether Philip has made an autonomous rational decision or not makes no difference to the fact that he is a “vulnerable person” and as such Oliver should follow the Church of England’s Safeguarding guidelines which mean he should gain Philip’s permission to share the conversation with someone else. If has already approached Oliver it surely shows there is some sort of relationship and he is indeed asking for help. Moreover, Philip intends to use medication which has been prescribed by his GP and morally the doctor has the right to know what Philip’s intentions are with regards to the medication. Oliver needs to find out why the medication was prescribed and why Philip thinks an overdose would be fatal and how much medication he would need to take. If the medication is for some incurable disease, then the ethical, but not the Christian attitude, towards Philip’s intended suicide could be different. However, in any case Oliver needs to know why Philip has been prescribed the medication in order that he may engage Philip in meaningful support. Little justification is necessary for actions that aim to prevent another’s suicide but are non-coercive. The more challenging moral question is whether further measures, such as telling Philip’s doctor against Philip’s wishes is justified. Is the “question of suicide intervention a question of how to justify paternalistic interference?”[15]
Even if Philip is suffering from some incurable illness, and we do not know that, all indicators show that suicide is a result caused by problems either physical or emotional. Individuals have the right to make bad or irrational decisions on their own behalf but the decision to end one’s life, when death is irreversible, justify intervention in another’s suicidal plans on the “soft paternalistic grounds” that suicide is not in the individual’s interests as they would rationally conceive these interests. According to Cholbi, this is the “no regrets” or the “err on the side of life” approach to suicide intervention.[16]
Oliver not only has a Christian duty to involve Philip’s GP but the backing of modern ethical arguments. As a minister he has to use every possible counselling means and prayer to persuade Philip to get treatment as well as preventing Philip from ending his own life. Philip is a child of God and we all have responsibility to protect God’s work. This will mean talking to Philip, praying with Philip and, if necessary by involving third parties, such as the GP, to help in preventing Philip’s suicide. Even if Philip is not willing to talk with the GP personally, the fact that he is planning to use drugs prescribed by the GP means that Oliver has an obligation to inform the doctor of Philip’s intentions of their misuse. Philip’s obvious intent, although possibly a cry for help, means a certain course of action should be taken because there is a clear and imminent danger that he will take his own life,
Bibliography
Appleby J: Safety First Five Year Report of National Confidential Inquiry into Suicide and Homicide by People with Mental Illness
Ed. Atkinson et alia: Christian Ethics and Pastoral Theology
Cholbi: Article in Stanford Encyclopaedia of Philosophy 2107
Kelly Chris and Eric Dale: Advances in Psychiatric Treatment in B J Psych Advances April 2011
Ed Muir David and Eileen Turner: Personal and Social Ethics St John’s Extension Studies
Puigliucci Massimo: Philosophy of Society rationallyspeaking.blogspot.com/2013/12/the-philosophy-of-suicide.html ( An argument against Cholbi)
wikipedia.org/wiki/philosophy_of_suicide
[1] https://wikipedia.org/wiki/philosophy_of_suicide
[2] Stanford Dictionary of Philosophy https://plato.stanford.edu/entries/suicide/
[3] http://www.lawandreligionuk.com/2015/01/06/cofe-services-after-suicide/
[4] https://www.thetimes.co.uk/article/church-finally-ends-ban-on-full-christian-funerals-for-suicides-j5bxsd72t
[5] Dworkin Ronald 1993 Life’s Dominion quoted in http://apt.rcpsych.org/content/17/3/214
[6] Stanford Encyclopedia of Philosophy https://plato.stanford.edu/entries/suicide
[7] Cicero 111 60-61 quoted in Stanford Encyclopedia of Philosophy
[8] Schopenhauer The World as Will and Representation quoted in https://en.wikipedia.org/wiki/Arthur_Schopenhauer
[9] Stanford Encyclopedia of Philosophy
[10] Beauchamp T.L. article from In Matters of Life and Death ed. T Regan quoted in Philosophy of Suicide
[11] John Stuart Mill On Liberty 1859
[12] Kessler 1994 Archives of General Psychiatry 51 quoted in http://apt.rcpsych.org/content/17/3/214
[13] Appleby J Safety First Five Year Report of National Confidential Inquiry into Suicide and Homicide by People with Mental Illness
[14] Battin M P The Death Debate: Ethical Issues in Suicide quoted in http://apt.rcpsych.org/content/17/3/214
[15] Stanford Encyclopaedia of Philosophy
[16] Cholbi Suicide: Philosophical Dimensions quoted in http://apt.rcpsych.org/content/17/3/214