Rational suicide discussed

Yesterday The Age ran with the story of a relatively healthy 83 year old who committed suicide despite having no terminal illness, but felt she had lived long enough. I'm not entirely sure why this was in the paper, and it worries me a bit that such stories encourage the idea of rational suicide; on the other hand, it is the type of story that probably makes politicians more nervous about legislatively addressing euthanasia as it makes it clear that activists in the field are often sympathetic to suicide to anyone who wants it. (Philip Nietschke is so nuttily obsessed with helping anyone who wants to die achieve their goal painlessly that he has taken to driving a van with nitrogen gas for sale.)

So it is interesting to see an article by a doctor who notes the difficulties with the idea of having a legal framework to allow for assisted rational suicide.  Here are some key points:

Much of the research from the palliative care field such as this study on patients with motor neuron disease, this one on a patient with locked-in syndrome and this review of life satisfaction in tetraplegic people tend to support the view that social factors affect quality of life much more than health-related ones. Among survivors of failed suicide attempts, many are subsequently glad they made it, and would not attempt it again. Impulsive or crisis-related suicidality would have to be strenuously screened for. Do we have those tools yet? Are they reliable enough to be ethically justifiable to use in practice?

It seems reasonable to conceive that the more physically disabled a person is, the more dissatisfied they must be with their life. The problem is that the research largely doesn’t support this view, at least not in the most highly disabled groups. It seems that you can’t make generalisations about a person’s quality of life just by looking at their medical records. This is why I begin to feel uneasy when cases like Beverley Broadbent’s are discussed....


How could we reliably distinguish between a case like Beverley Broadbent, who is clearly making a long-considered decision with rational forethought free from mental illness or social coercion, and another who hasn’t been through the same emotional and mental journey, or who may be getting a nudge along? And what about younger people who have survived into their 40s and 50s with conditions like cerebral palsy and spinal cord injury? They are experiencing similar physical and social disadvantage to the elderly, but at a much earlier age. Would they be allowed to apply as well?

Much, much more research is needed about any proposal for voluntary ending of a life in the absence of terminal disease. As a humanist, I support the right to choose an early and dignified exit from intolerable circumstances. As a doctor, and a pragmatist, I have a lot of trouble thinking my way towards a legal and social framework in which this could be ethically brought about.

He ends on a point that I don't agree with, though:

We need to have a mature conversation about this. A conversation which respects shocking and awkward points of view.

 Why?

Those inclined to rational suicide have been around for ever.  Why is special accommodation for them needed now?