Deciding How to Die

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

“I have never seen a better planned death than the one Danny designed.” - Philip Tetlock

Occasionally, I am stopped short by a news item that seems to have profound social psychiatric impact. Usually, it also has major personal meaning. Yesterday, I came across such an article.

“There’s a Lesson to Learn From Daniel Kahneman’s Death” ran the title of the New York Times’ guest essay yesterday by 2 philosophy professors.¹ What was this lesson I should learn, I wondered? I am turning 79 shortly, and my wife and I are in the midst of more medical problems and facing the ever-shortening of time to live.

I had been thinking enough of my own death that I have written 3 evolving versions of my own eulogy over the last decade, the last one being posted in Psychiatric Times on July 24, 2023.² I recommended our readers do their own.

Psychiatric Times has been covering the diverse ethical views on euthanasia and physician-assisted suicide for years. Over 21 years ago, Herbert Hendin, MD, wrote “Commentary: The Case Against Physician-Assisted Suicide: For the Right to End-of-Life Care.”³ He defined euthanasia as a physician causing a patient’s death by injecting lethal medication. The most notorious cases of that involved the pathologist Jack Kevorkian, MD, otherwise known as “Dr Death,” who was incarcerated for doing so on his own.⁴ Physician-assisted suicide, on the other hand, involves the physical prescribing the lethal dose, but the patient taking it.

Over recent years, Mark Komrad has written many articles for Psychiatric Times on these controversial practices. Last year, he and some other expert coauthors on the subject matter wrote this cover story: “Beyond Terminal Illness: The Widening scope of Physician-Assisted Suicide in the US.”⁵ Basically, it seemed that they offered the opinion that physician-assisted suicide is not compatible with the physician’s role.

Another article for Psychiatric Times on the subject from another perspective was written last year by a disabled individual, titled “The Medical Slope of Assisted death: From ‘Who May’ to ‘Who Should.’”⁶ His concern was for a slippery slope toward earlier and perhaps premature death, especially when euthanized is defined as medical care.

Periodic reviews on the subject suggest the conundrum of the practices.⁷ From a bioethics perspective, the concept of dignity is important, putting a dignified death over paternalism. Feelings of worth is posited as crucial to living.

It was the very essence of a dignified life that seemed essential to Kahneman’s decision of how and when to die. He had planned to die by assisted suicide on March 27, 2024. He explained that he had believed since he was a teenager in dying before indignity. His ultimate decision was also consistent with the slow thinking process of his best-seeing book.⁸

By that day, he was still enjoying things, but reported his kidneys were deteriorating and some mental lapses were occurring. Some loved ones disagreed but eventually came to support his decision. His wife had already died. He spent the week before dying in various activities. Among them, he took his family to his childhood home and playground before the Nazi’s came and his Jewish family went into hiding in Southern France, perhaps suggesting an important psychological connection to his death decision.

The information about how and when he died was not reported until recently, a year or so later. Kahneman picked Switzerland because assisted dying is legal if you are at least 18, of sound mind, not interested in monetary gain, and are able to self-administer the legal dose. In other words, Switzerland had a policy that allowed relatively healthy people to end their lives because they see their lives as completed. However, every such situation triggers a mandatory billed investigation as a nonnatural death.

When I did a social psychiatry chapter review on death and dying a couple of years ago, it was apparent that different cultures had various practices and beliefs on how to die.⁹ There were some, like natives in the Arctic, who would quietly go out into the wilderness to die when their sense of usefulness was over. On the other hand, Black Americans in the United States seemed to be averse to accepting any attempt that might shorten life, perhaps due to the historical experience of dying early in America and some distrust of mainstream medicine.

For myself, if I have the opportunity, I would definitely consider Kahneman’s option. I would not be surprised if and when such decisions become personal rather than professional, the meaning changes. Some psychiatrists against physician-assisted suicide in their professional opinion might change their opinion when they personally experience the situation.

It seems the lesson is that we should be able to consider a structured process that includes processing the decision with loved ones, a general objective psychological assessment of the decision, and perhaps a specially trained medical team to help in such planning. I suppose some or all of that could be begun with one’s personal physician. In essence, this would be planned death with dignity if an opportunity arises. Or is this example just a reflection of the rational and genius thinking of Kahneman and not so generalizable?

What do you think professionally and personally?

Dr Moffic is an award-winning psychiatrist who specialized in the cultural and ethical aspects of psychiatry and is now in retirement and retirement as a private pro bono community psychiatrist. A prolific writer and speaker, he has done a weekday column titled “Psychiatric Views on the Daily News” and a weekly video, “Psychiatry & Society,” since the COVID-19 pandemic emerged. He was chosen to receive the 2024 Abraham Halpern Humanitarian Award from the American Association for Social Psychiatry. Previously, he received the Administrative Award in 2016 from the American Psychiatric Association, the one-time designation of being a Hero of Public Psychiatry from the Speaker of the Assembly of the APA in 2002, and the Exemplary Psychiatrist Award from the National Alliance for the Mentally Ill in 1991. He presented the third Rabbi Jeffrey B. Stiffman lecture at Congregation Shaare Emeth in St. Louis on Sunday, May 19, 2024. He is an advocate and activist for mental health issues related to climate instability, physician burnout, and xenophobia. He is now editing the final book in a 4-volume series on religions and psychiatry for Springer: Islamophobia, anti-Semitism, Christianity, and now The Eastern Religions, and Spirituality. He serves on the Editorial Board of Psychiatric Times.

References

1. de Lazari-Radek K, Singer P. There’s a lesson to learn from Daniel Kahneman’s death. New York Times. April 14, 2025. Accessed April 15, 2025. https://www.nytimes.com/2025/04/14/opinion/daniel-kahneman-death-suicide.html 

2. Have you written your own eulogy? I have, here is its update, and why i would recommend doing your own. Psychiatric Times. July 24, 2023. https://www.psychiatrictimes.com/view/have-you-written-your-own-eulogy

3. Hendin H. Commentary: the case against physician-assisted suicide: for the right to end-of-life care. Psychiatric Times. February 1, 2004.

https://www.psychiatrictimes.com/view/commentary-case-against-physician-assisted-suicide-right-end-life-care

4. Moffic HS. The ethical way: Dr. Death and the meaning of life. Clinical Psychiatry News. September 2007. Accessed April 15, 2025. https://cdn.mdedge.com/files/s3fs-public/issues/articles/70636_main_5.pdf

5. Komrad MS, Hanson A, Geppert CMA, Pies RW. Beyond terminal illness: the widening scope of physician-assisted suicide in the US. Psychiatric Times. June 6, 2024. https://www.psychiatrictimes.com/view/beyond-terminal-illness-the-widening-scope-of-physician-assisted-suicide-in-the-us

6. Friesen G. The medical slope of assisted death: from "who may" to "who should." Psychiatric Times. Januar 3, 2025. https://www.psychiatrictimes.com/view/the-medical-slope-of-assisted-death-from-who-may-to-who-should

7. Picón-Jaimes YA, Lozada-Martinez ID, Orozco-Chinome JE, et al. Euthanasia and assisted suicide: an in-depth review of relevant historical aspects. Ann Med Surg (Long). 2022;75:103380.

8. Kahneman D. Thinking, Fast and Slow. Farrar, Straus and Giroux; 2011.

9. Moffic HS. Social psychiatry: death and dying. In: Gogineni RR, Pumariega AJ, Kallivayalil R, et al, eds. The WASP Textbook on Social Psychiatry. Oxford University Press; 2023.