Suicide as a Policy Matter

Karl Muth argues that policymakers should approach suicide as a choice, and not a crime or a disease.

After a recent suicide in my own family, and having recently revised my will (and associated legal documents, including those specifying that heroic and extraordinary efforts not be made to prolong my life if I am terribly ill or mortally wounded), I’ve been thinking about the conversations we have about suicide. It is these conversations, often, that drive policy – since policy in areas like organ donation and euthanasia are led by public narratives at least as often as they’re led by empirical policy analysis.

An unfair judgment is made by observers, the media, and the law in the case of suicide, however. For years, states in the American south (led by Texas) voided the wills and codicils of those who committed suicide. The idea was that, by punishing heirs, public policy would run counter to suicide and dissuade people from committing suicide. If this worked, however, we should have seen a deterrent effect at least roughly correlated with the size of the deceased’s or deceased-to-be’s estate. I’ve seen no evidence such policies deterred suicide.

These policies to deter suicidal people – in a way that was ignorant of both contextual and mental health factors – were simple, and derived from German and French (Vatican-influenced) rules that forbade the passage of land contracts and land grants as a result of suicides. This led to elaborate schemes to claim those who had committed suicide had died in other ways to ensure inheritances did not escheat to the church (perhaps most famously, by inventing deaths in the Albigensian Crusade among landholders in Alsace, who actually committed suicide due to the financial troubles and poor harvests of Alsacean major plotholders the time).

I don’t much prefer the phrase “committed suicide” which does, in itself, suggest that suicide should be criminalized or is a fundamentally amoral act. I don’t believe this to be true and don’t believe public policy should embrace as fact either of these interpretations: 1) that suicide is generally the result of mental illness or 2) that suicide is something society should wholesale discourage. There are perfectly reasonable scenarios in which a person, unafflicted by mental troubles, might face financial ruin, public embarrassment, or political doom that would lead a reasonable person to suicide.

But even this standard is flawed: The standard – from a legal and public policy standpoint – must be subjective rather than objective, it must not hinge on whether a reasonable person or some third person would commit suicide under the same circumstances, as it is not the circumstance but the circumstance as observed that most often motivates the act. This is what leads some to the (incorrect) belief that mental illness is a prerequisite to suicide, that only an insane interpretation of the situation could lead one to kill himself (or herself).

The most troubling public policy trend, which is merely the symptom of a broader trend in public opinion, is that suicide is acceptable when it is a type of euthanasia. The best way to visualise this argument is to picture two people, A and B. A has been recently diagnosed with incurable cancer that will be painful and expensive to treat. B is perfectly healthy in the physical sense, but has engaged in a series of transactions that may subject him to millions of pounds in civil penalties, the forfeiture of his law license, and potentially even a period of incarceration. The prevailing Anglo-American sentiment (and public policy) runs in favour of the concept that A committing suicide is understandable (and perhaps even admirable), while B’s suicide is not.

This has the indirect effect of delegating the decision to commit suicide to the medical profession. This is not only unfair in the expectations (and burdens) it places on physicians, but unfair in the loss of agency it creates for patients. In essence, by saying that A’s suicide is reasonable while B’s suicide is not reasonable, as policymakers we’ve “outsourced” the suicidal decision away from A and B and to A’s physician and B’s physician. This is inequitable to all parties involved. Further, this positions suicide as an acceleration of illness rather than a conscious decision by a person to end his or her life.

As policymakers and advisors to policymakers, we must stop treating suicide as an arbitrary posthumous diagnosis of mental illness and must stop forcing medical professionals to be unwilling intermediaries in our decisions to kill ourselves. The use of these proxies and stereotypes and simplifications is not only intellectually disappointing, but philosophically dangerous. Until we realise that suicide is a choice, and not a crime or a disease, we will not be able to influence the behaviour of those considering this serious, and irreversible, path.