Suicide Prevention Ought To Be Illegal
To be clear, I’m not talking about the sort of “suicide prevention” that involves raising awareness about mental health and providing resources to those seeking help. The vast majority of us will agree that increasing human happiness is desirable, and I am no contrarian. When I refer to suicide prevention, I am referencing processes which actively prevent an individual from committing suicide, particularly involuntary commitment.
As the title implies, this post will discuss suicide and mental illness, so if you are especially sensitive to or offended by such material, I would advise against reading further.
Introduction
When a loved one expresses a desire or a plan to commit suicide, it is natural to feel scared, upset, angry, betrayed, helpless, or disturbed. Most of you will offer a helping hand and a shoulder to cry on, suggest accessible mental health resources, or remind them of the beauty of life and all the people who love them. For many of you, such superficial countermeasures are simply not enough. Platitudes, positive thinking, and promises of happy futures certainly won’t hurt, but mindfulness isn’t going to reverse such a severe deficit in the will to live. Your loved one, this person who you love so dearly, is profoundly ill, their desire a perversion of the human psyche; as they are so obviously incapable of reason, mere words cannot ensure their continued presence to your satisfaction. You may be so afraid, so distraught, so desperate, that you will do whatever it takes to give them a chance at life.
You will do whatever it takes to stop them.
Such a response is understandable, socially respectable, a clear display of your loyalty and passion, and, above all, selfish.
The vast majority of us will agree that torture for the sake of torture is unacceptable. Sure, our theoretical sadistic perpetrator finds it incredibly gratifying, but his urges and pleasures do not give him the right to inflict suffering upon non-consenting victims. Even if multiple perpetrators act as a group, even if this group claims their moral philosophy or personal values or religion permits them to torment outsiders, we still maintain the victim’s individual rights and condemn the perpetrators. Many of you would not allow an animal to be treated in this manner. The fact remains that no amount of emotional gratification or distress permits you to inflict suffering upon or violate the bodily autonomy of another conscious being.
So, why is encouraged, even mandatory, to force an individual who is suffering, who seeks to end their suffering, to continue to live? Why is it encouraged, even mandatory, to detain them, to forcefully imprison them and drug them until they repeat the correct platitudes and complete the correct actions and convince you, really persuade you, that they think the right way? When you forcefully extend the life of a suicidal individual, you inflict suffering upon them because it feels good, no different than our theoretical sadistic except in social palatability. Your noble intentions, your emotional gratification and alleviation of all that unpleasant fear and helplessness and distress, does not give you any right to infringe upon your loved one’s rights.
Addressing Common Arguments for Suicide Prevention
There are numerous objections to permitting suicide; I will list some of the most common below.
Suicide is the ultimate irreversible decision. If an individual who is currently suicidal continues to live, they may find happiness. Many who have survived a suicide attempt go on to live fulfilling lives and regret their attempt.
Suicidal individuals are not reasonable or competent, and cannot be trusted to care for themselves, either because they are feeling intense emotions or because the desire to die is so perverse and unnatural as to imply severe illness in and of itself. (This is often paired with the first reason.)
When a person commits suicide, they devastate their loved ones and abandon all who depend on them. Suicide is extremely disruptive, and a society that allows it will collectively suffer.
A moral philosophy, personal values, or religion does not permit suicide and/or allowing another to come to harm, so subscribers to these frameworks are obligated to prevent suicide.
The fourth objection is not difficult to refute; your moral philosophy, personal values, and religion do not give you the right to infringe upon the freedoms of others. Even if you personally disagree, aligning yourself with theocratic regimes that subjugate women and our theoretical cult of sadistic tormentors, the laws of the United States (and most other democratic nations) do not. To the three religious members of LessWrong, I am a practicing Christian myself, and accordingly do not aim to promote sin or offend the religious, though I am happy to debate the permissibility of suicide in the comments. The third objection is similarly trivial; one’s emotional gratification and dependence upon an individual does not entitle them to infringe upon the freedoms of that individual. Even if you personally disagree, aligning yourself with regimes that permit slavery for economic gain or enforce “socially harmonious” behavior at the expense of individual expression, the laws of the United States (and most other democratic nations) do not.
The second objection may be rejected on the basis that suicidal individuals are not incompetent nor beyond reason. While a few individuals may impulsively decide to commit suicide, the decision is a calculated and well-planned for many others; besides, intense emotions do not exclude those who experience them from autonomy and responsibility. The notion that perverse or unnatural desires are proof of incompetence and therefore justification for protective custody is not legally recognized; homosexuals, for instance, are not regarded as incompetent by the laws of the United States (or most other democratic nations), and are free to do as they please.
The first objection relies upon the notion that suicide is an irreversible decision which many come to regret, as evidenced by suicide attempt survivors who do not reattempt. Unfortunately, this argument suffers from the most literal form of survivorship bias; those who are less committed to dying, and thus more likely to regret a suicide attempt, will use less lethal methods, while those who are more committed to dying, and thus less likely to regret a suicide attempt, will use more lethal methods. Accordingly, surveys, which are obviously limited to those who survived suicide attempts, will record a much higher proportion of those who would regret a suicide attempt. Further, the regretfulness of suicide attempt survivors is largely irrelevant to the legality of suicide prevention; the role of the government is to protect individual rights and act within the interests of its citizens, not to force citizens to follow a certain ideal, no matter how well-intentioned. At the time of the attempt, the suicidal individual is fully understanding and accepting of the consequences of their actions, and preventing a process they have consented to infringes upon their personal freedoms.
The Role of the Government
My central argument, as implied by the title, is that suicide prevention ought to be illegal. It is not difficult or costly to execute; simply reduce the criteria for involuntary commitment and mandatory reporting to “immediate risk of danger to others”, and enforce the law accordingly. The majority of the following section will focus upon specific cases.
Medically Assisted Intentional Death
MAID is a process in which a mentally competent and terminally ill patient seeks a medically-induced death. In some jurisdictions, the eligibility of MAID is expanded to those with grievous and incurable medical conditions. Introducing the assistance of a physician or the presence of a painful or fatal medical condition does not negate the arguments above; motivation and method do not negate the autonomy of the individual who chooses to end their life.
Coercion
When an individual is pressured to commit suicide, particularly by those in a position of authority, they have not made the decision to end their life autonomously. In such cases, the victim should not be punished; rather, the perpetrator and their influence ought to be separated from the victim, by force if necessary. Precedent for prosecuting suicide coercion has already been established; following the death of Conrad Roy, in which Roy’s girlfriend Michelle Carter coerced Roy into committing suicide, Carter was convicted of involuntary manslaughter.
Minors and the Legally Incompetent
The largest gray area exists around minors and the legally incompetent; while it is obvious that such individuals cannot consent to MAID or other forms of assisted suicide, whether they ought to be actively confined when attempting suicide is more difficult to answer, as such individuals lack complete autonomy but retain some personal freedoms. In this particular situation, their legal guardian’s obligations to protect their well-being override any such freedoms, so suicide prevention ought to be permitted.
Helping the Suicidal
When you are suicidal, it is natural to be hesitant to tell your loved ones. You know they will feel scared, upset, angry, betrayed, helpless, or disturbed, and you would never cause them such distress unless you trusted them dearly and believed they could change your situation. You hope they will offer a helping hand and a shoulder to cry on, suggest accessible mental health resources, or remind you of the beauty of life and all the people who love you; at the end of the day, you don’t want to die, just to escape. Unfortunately, for many of your loved ones, providing the support you desperately need is simply not enough. They will not understand the pain you are in, will not listen to the reasons you have decided to end your life. Your loved one, this person who you love so dearly, will simply think you profoundly ill, your desire a perversion of the human psyche; as they so obviously consider you incapable of reason, nothing you could ever say will matter more than the continued presence of the image of you they have constructed. They will be so afraid, so distraught, so desperate, that they will do whatever it takes to keep you alive, even at the expense of you and your community.
Mental health professionals are no better; breathe the word “suicide” in their presence and you’ll be whisked away to some institution, where you’ll be closely monitored and likely drugged for an indefinite period of time. Such a scenario would burden your loved ones and tarnish any reputation of yours that remained. Your loved ones deserve better.
You decide not to tell anyone and get it over with.
By prohibiting suicide prevention, the stigma surrounding suicide ideation is reduced. The afflicted can speak to their loved ones and be honest with mental health professionals without risk of imprisonment, and are empowered to seek treatment on their own terms. Further, should an individual decide to end their life, they may seek the least painful and most effective means without fear of discovery. Suicide prevention infringes upon individual rights and incentivises those who suffer from suicidal ideation to hide their condition until it is too late. Do not allow emotional gratification to override your loved one’s well-being; give them the autonomy to make the correct decision for themselves, and provide your support for them regardless of their choice.
Have you seen “Two Arms and a Head”?
ETA: For those who haven’t, it is not a work of fiction. Also reviewed on Astral Codex Ten.
Thank you for the recommendation. I will read it this week.
Says who? That’s as much of a moral claim as anything. You may or may not have the legal right .. but in this cases you do, or you would have nothing to object to.
Obviously, that’s a continuum.
That doesn’t imply “never intervene”, it implies “make a judgment”.
That will help some and harm others. There are people regret their suicide attempts, and many of them were saved by interventions.
Thank you for your thoughtful comment! You make many good points.
The notion that one’s moral philosophy, personal values, and religion do not give one the right to infringe upon the freedoms of others is cruxy; if you disagree, than my conclusion does not apply to you. However, I will note that a society in which everyone can impose their values upon eachother (or, worse, a society in which one group imposes their values upon everyone else) would quickly devolve into chaos or tyranny. I would also like to avoid isolated demands for rigor; do you continue to believe people ought to be able to impose their values upon others in other contexts, such as conversion therapy (borne of the values condemning homosexuality and potentially protecting homosexuals from eternal torment) or restrictions upon women’s education (borne of the values denoting women as inferior to men)?
You are correct. I apologize for any confusion my writing has caused; by “suicidal individuals are not incompetent nor beyond reason”, I intended to say that suicide ideation does not inherently render one mentally incompetent. If an individual is mentally incompetent, they ought to be prevented from committing suicide; if an individual is mentally competent, they ought to be allowed to exercise their autonomy.
Using force on a mentally competent individual cannot be justified by your belief that they will regret their actions later. Allow me to restate a sentence from the post:
Of course, this is irrelevant to you if you believe that personal/religious values justify the use of force.
That isn’t the point. The point is that the argument behind Never Intervene is self defeating: you are imposing a lack of intervention on people who might want intervention, and you are doing so because it’s your own belief …you haven’t shown it is a principle that transcends merely subjective preferences.
I was not calling for the maximum amount of intervention or imposition: I was noting that there is no neutral ground.
Is there a completely reliable way of determining that?
I suppose that would be a problem if you had a reliable method of determining competence. Otherwise it’s a judgment call.
Thank you for your comment! You raise some good points, particularly regarding competence.
By definition, if you want to be committed, you have not been involuntarily committed. Involuntary prevention is what I take issue with; I apologize if I have been unclear. If an individual indicates that they would like others to prevent them from committing suicide or they would like to seek assistance for suicidal ideation, they ought to receive the help they require.
My argument is that we all have subjective preferences, and since none of these preferences are inherently superior, we therefore ought to allow each mentally competent individual to decide and act upon their own preferences. I will attempt to demonstrate that it is a principle when my karma recovers or I am able to make another post. (Whichever comes first.)
Given that nobody here is omniscient, there is no perfect way to determine anything; however, perfect ought not to be the enemy of good. Any adult is mentally competent by default, and may only be considered mentally incompetent if they are currently impaired (severe dementia, psychosis, severe hallucinations, etc). In general, it is safe to assume that those who do not have and do not have a history of mental impairment are mentally competent, and those who have or have a history of mental impairment are not mentally competent.
It’s not that straightforward. Some people might ,while mentally capable, give general consent to being committed if suicidal, but later withdraw it , while incapable ,at least in a professionals judgement.
That’s not well defined in the case above.
But you’re not calling for less involuntary commitment.
Obviously to have time for treatment. Do you assume that there are treatments for suicidal ideation? In some cases suicidal ideation is literally inherently temporary (for example for a case of bipolar depression).
This is not how treatment for suicidal ideation works. One good account might be: https://www.ted.com/talks/sherwin_nuland_how_electroshock_therapy_changed_me
Thank you for your comment! Yes, I am aware that there are treatments for suicide ideation, I simply disagree with applying them by force. I am also aware that suicide prevention, involuntary commitment, and treatment for suicide ideation differ from place to place; in that particular section, I was referring to one treatment. I apologize if I appeared to be generalizing.
but do you generalize the idea of never treating people by force?
Is there an exception for psycoisis, halluciations, delutions, paranoia—which are very frequent concounders of suicidal ideation?
Do you think, is it fine to treat people “by force” in thid cases?
My apologies if I was unclear; I am opposed to using force on mentally competent individuals. I would not consider those experiencing psychosis, delusions, and other severely impaired perceptions of reality as fully mentally competent. Yes, in these instances it is acceptable to treat others by force.
I see what you mean, thanks for clarifying.
Personally, I’m conflicted. On one hand I have beeen involuntarily hospitalized (without need), which was bad and traumatic experience. On the other hand, I think there are cases where people would reject treatment (for depression, for example), not knowing what are the options and efficiency, and so hospitalization is be life-saving.
We can do better in any case, this is for sure.
Suppose that an individual decided to commit suicide because of a deeply flawed world model. Does it mean that it’s unethical to correct the model and see if the individual’s case against continuing to live does persist?
I apologize for the lack of understanding on my part, but when you refer to “a deeply flawed world model”, do you mean that the world in which the individual lives is deeply flawed, that the individual perceives the world as deeply flawed, or that the individual has a deeply flawed perception of the world?
If the individual’s environment is deeply flawed, and this motivates them to end their life, it is absolutely not unethical to correct the flaws in their environment. If the individual’s outlook on the world motivates them to end their life, it is absolutely not unethical to convince them that the world is not a bad place or that suicide is not the optimal solution. However, it is unethical to use force in your attempts to do so.
If an individual has a deeply flawed perception of reality (as in, “psychosis, late-stage dementia”, not “outlook on the world is disagreeable or more depressing than average”), they are not mentally competent and should therefore be prevented from committing suicide.
I meant a deeply erroneous world model which, if true, would imply that a major part of life is no longer worth continuing. I apologize for confusion.
Again, it depends on whether or not the individual is mentally competent. If the deeply erroneous world model is borne out of hallucinations of bugs coming out of the walls to eat you, then no, it is not unethical to prevent this individual’s suicide and correct the model with the appropriate therapy and anti-psychotics. If the deeply erroneous world model is held by a mentally competent individual who believes something false (such as a false diagnosis of dementia, for instance), then it is not unethical to correct this model by convincing the individual that the distressing belief is false, though it is unethical to use force to do so.