Is Suicide Immoral?

[[{"type":"media","view_mode":"media_crop","fid":"22964","attributes":{"alt":"Suicide","class":"media-image media-image-right","id":"media_crop_5964972850870","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1739","media_crop_rotate":"0","media_crop_scale_h":"188","media_crop_scale_w":"160","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":" ","typeof":"foaf:Image"}}]]I remember my uncle’s final phone call with unusual clarity, since it came the same week in 1992 that Johnny Carson went off the air. In our yard, the late-May lilacs were starting to fade, and the warm weather was already easing us toward summer. I had been out when my uncle phoned, but our answering machine picked up the message: he was calling because my mother had been “noodging” him--not because he really wanted to speak with me. Having recently lost his job, my uncle sounded angry and enervated, as if he had marshaled his last bit of energy to fulfill this final duty. I tried calling him back, but there was no answer and no means of leaving a message. A few days later, my uncle was dead of a self-inflicted gunshot wound, leaving a wife and two young children behind. More than twenty years later, the anguish of his suicide still tears at our family. And the questions we ask ourselves have never gone away: Could we have prevented this tragedy? Did we fail our loved one? Did we not see the clues? How could we have been so blind? And what had we done to deserve such pain?

Psychiatrists are not moral philosophers by training, and the question of whether or not suicide is “immoral” is arguably the wrong one for psychiatrists to ask. As mental health professionals, we are, understandably, more concerned with the day-by-day challenges of detecting “suicidal ideation”; determining who is at high-risk for suicide; and treating the psychiatric conditions most commonly associated with suicide, such as major depressive disorder. And yet, as Dr Cynthia M.A. Geppert points out, “the work of healing and caring is intrinsically about values and virtues.” (personal communication, 12/1/13). Thus, the ethical status of suicide is not a question psychiatrists can ignore, any more than we can ignore human values in general. After all, our duty to preserve and protect life is founded on moral values, even if they are so deeply embedded in our medical ethos that we no longer sense their moral underpinnings.

Recently, the moral status of suicide has been scrutinized by the poet and philosopher Jennifer Michael Hecht, in a book titled, Stay: A History of Suicide and the Philosophies Against It. Hecht wrote the book in the aftermath of two suicides-both victims were close friends and fellow poets. In essence, Hecht argues that suicide cannot be evaluated solely in terms of “personal autonomy,” as some modern ethicists might claim; rather, we must hold suicide up to the clarifying light of communal values. In an audiotape accompanying her book, Hecht argues that “When a person kills himself, he does wrenching damage to the community." And this, surely, must be counted among the “moral harms” of deliberate self-destruction.

None of this means that we should affix a scarlet letter to those who contemplate or attempt suicide. Nor should we endorse the benighted view that suicidal people are “selfish” or indifferent to the feelings of others. (See, in this regard, the letter from Robert Gebbia, Chief Executive, American Foundation for Suicide Prevention, in The New York Times, December 10, 2013, in which he rebuts a column by David Brooks, as well as some of Hecht’s claims.¹) On the contrary, the suicidal person is already burdened by the darkest of thoughts and, often, by corrosive self-loathing-so the last thing we should do is add to the person’s suffering. Rather, it is our task to comfort those so afflicted, not to condemn suicide “from the pulpit.”

Of course, it is also our charge to understand the genesis of suicide, and to treat its underlying psychiatric causes. This is not to say that all suicides are a consequence of psychopathology. But even if we accept the notion of a perfectly “rational” suicide-a dubious concept, in my view-the communitarian argument Hecht is making remains valid. Any suicide-even in the direst circumstances, and even after much deliberation--leaves a grotesque gash in the emotional life of families and communities. It may take years for such a wound to heal, if it heals at all. I can attest to suicide’s emotional damage in the micro-community of my own family, following my uncle’s death. To this day, my uncle’s widow and her daughters bear the deep emotional scars of his action. And I, too, still second-guess my own involvement, often wondering if more persistence on my part might have prevented my uncle’s death.

For Hecht, suicide’s communal damage is a compelling reason to urge our suicidal loved ones to “stay”-- and to insist that life isn’t too hard to bear; only “almost too hard to bear." As psychiatrists, we can discuss the issue of communitarian values with suicidal patients who wish to do so, without in any way condemning their suicidal feelings or impulses.

Acknowledgments: I greatly appreciate the suggestions and comments of my colleagues, Cynthia M.A. Geppert, MD, PhD, and James L. Knoll IV, MD. The views stated here, however, are my own.

For further reading:

Moffic HS. Suicide Among the Elderly. Posted on Monday, November 11th, 2013. (This posting by Dr. Moffic is followed by many informative comments).

Also see the website of the American Foundation for Suicide Prevention.

This article has been updated since its original post date of 12/11/2013.

References:

1. Gebbia R. Letters: understanding suicide: mental illness, not irony. New York Times. December 10, 2013. http://www.nytimes.com/2013/12/11/opinion/understanding-suicide-mental-illness-not-irony.html. Accessed January 30, 2014.