I wrote the following a year ago, but, for various reasons, didn’t post it. Reading Professor Brian Draper’s excellent op-ed on older male suicide today, I decided the time was right to share my reflections on these complicated issues.
I spend a lot of time thinking about death. It’s kind of an occupational hazard. But lately I’ve been thinking a lot about suicide and euthanasia, and the murky area in between.
The dementia research that my colleagues and I conduct focuses on quality of life, particularly for people living in residential aged care facilities. I’m yet to visit one of these facilities and not cry in the car on the way home. Similarly when I talk to families who are caring for people with advanced dementia at home, my heart breaks. Families says things like “She wouldn’t want to live like this”…. “We wouldn’t let an animal suffer, but he has to”… “Hopefully by the time I get to that stage, euthanasia will be legal”. Dementia’s a bitch (as are many terminal illnesses) and people want the option to die with dignity, so I’m definitely pro-euthanasia.
But I also conduct research on suicide. In that research I encounter people who are isolated, trapped by circumstance, or in terrible psychological pain. I also hear stories of families devastated by a loss they didn’t see coming and cannot understand. Suicide’s a bitch and the tragedy is that it could often have been prevented. So I’m definitely anti-suicide.
But can you be pro-euthanasia and anti-suicide? At their core they’re both about ending a life and many would argue that there is no difference. From my perspective though, the difference comes down to compassion and suffering. Euthanasia is about offering compassion; suicide occurs in the absence (or perceived absence) of compassion. Euthanasia is about alleviating suffering when all other options have been exhausted, while the suffering that leads to suicide can often be alleviated with psychological therapies and better support systems. I think it’s possible to be pro-euthanasia and anti-suicide – to recognise that there is no dignity in dying a slow, painful death, while simultaneously acknowledging that we can do more to support people for whom an early death really would be a tragedy.
What concerns me is that the current public debates seem to suggest that you can only support one or the other. Euthanasia and suicide have both had a lot of coverage in the Australian media lately. The suicide prevention campaigners have set an ambitious goal of reducing suicide rates by 50% in the next 10 years and programs like RUOK Day and Mates in Construction are helping to normalise conversations about suicide. This is a good thing. At the same time, Philip Nitschke and other euthanasia campaigners are continuing to push for laws that will allow doctors to openly support euthanasia for patients who are terminally ill. This is also a good thing. Yet neither side seems willing to acknowledge the overlap in their work. Not every suicide is a preventable tragedy and not every act of euthanasia occurs when all other options have been exhausted. Some suicides might be better described as euthanasia and some acts of euthanasia as suicide.
So what can we do? To be clear, these are merely my reflections, from where I sit right now, this very minute, informed by the experiences that have brought me here. And as such, they are no more or less valid than anyone else’s. I’m also incredibly mindful that this debate takes on new complexity in the context of dementia, where issues of capacity and consent are complicated by cognitive impairment (see here, here, here, here, and here for more on this). But I would like to encourage a public discourse that acknowledges that death – like most things in life – exists on a spectrum. Some deaths are bad, some deaths are good, most lie somewhere in between. If our ultimate goal is a good death, suicide prevention campaigners need to acknowledge that until euthanasia is legalised, they will never be able to prevent all suicides. And euthanasia campaigners need to work harder to develop safeguards and referral pathways for people who could be better supported in other ways.