Sunday, October 4, 2009

Ready for Death? You Must be Depressed.

Among the many arguments against the legalization of assisted suicide are:

*the sanctity of life is determined by God and must be protected according to His will
*a "slippery slope" erosion of the sanctity of any stage of life will lead to others
*AS will lead to the victimization of the aged, disabled and infirm
*legalizing AS illegitimizes suicide prevention efforts
*the need for AS would be eliminated by better palliative care and pain cessation
*and only the depressed wish for AS or suicide

The connection between depression and suicide is accepted and universally integral to suicide prevention efforts. Thus, many opponents to assisted suicide assume that those facing impending death only wish for assisted suicide when they are depressed. Whether that depression can be attributed to fear of impending death, the pain of the illness, loneliness, a loss of control over one's body, or other factors, adequate treatment for depression is an assumed viable solution for a desire to die, or in the parlance, for not "accepting each day of life as a gift.

The assumption that the desire for death is directly tied to depression over-simplifies the more complicated psychic - and physical - state of those in terminal conditions requesting assisted suicide. A desire to hasten death - death is already pending - extends beyond depression. Death is unavoidable (barring miracle, a subject I will have to write about at another time) and is not caused by the patient, as with suicide, but by the terminal disease of condition. The patient does not wish to die but will die.

Those wishing for assisted suicide can hope to maintain dignity in the face of incurable pain; can have accepted death as inevitable and near; and/or can wish to determine the time and place of their death according to their innate rights. Depression can be a symptom of terminal illness and pending death but it is not the sole cause. Curing depression in the terminally ill won't prevent death.

Yet, in countries where the assisted suicide movement is gaining ground with the courts, public opinion and the medical industry, opponents continue to address treatment of depression as a solution for those seeking assisted suicide. As part of their annual celebration of "A Day for Life" the Irish Catholic Bishops' Conference focuses this year, commendably and following last year's topic of mental health, on suicide. Unfortunately, the conference errantly includes the issue of assisted suicide in their statement. They write:

Life matters. It is commonly accepted that those who die by suicide don’t want to die; they simply wish to end their pain. Suicide prevention is, therefore, a duty of everyone in our society. In this area we need to be particularly concerned for other people and sensitive to their difficulties." You are Precious in my Sight addresses pastoral issues around suicide such as why some people consider suicide and the issue of assisted suicide. Bishop Fleming said "Our Pastoral Letter is for everybody. It contains a special Day for Life prayer and it reminds us that "the message of the Gospel is that, whatever has happened to us, and whatever we have done, we can never be separated from the love of God in Jesus Christ. Pain, even tragedy, are never God’s last word.'

Because assisted suicide, the willful, self-administration of lethal drugs for the sake of hastening death by mentally competent, terminally ill patients, is often confused with suicide, perpetrated by depressed or mentally ill individuals, advocates tend to shy from the term, preferring death with dignity or aid in dying.

By separating depression from the desire for assisted suicide, we can approach the assisted suicide movement from a more practical, rights-oriented, dignity-permitting and scientific standpoint. Curing depression and the causes of suicide is a commendable effort by the Irish Catholic Bishop's Conference. However, curing death is not within their purview.

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