Suicide and Bodily Autonomy

When do we have the right to intervene

Studies of mental functions, behaviors and the nervous system.

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Re: Suicide and Bodily Autonomy

#21  Postby Fallible » Oct 31, 2018 8:19 am

In other arenas, autonomy is considered the most important thing. That doesn't mean there are no 'speed bumps'. I don't think I can recall any time at which I told a person to go right ahead and kill themselves the first time they expressed to me their desire to do so. The process often spans weeks of intricate discussion and proposal of alternatives, analysed one by one. Still at the end of that process, a small number will clearly and rationally state that their choice is still the same. Protect mentally ill people from themselves by all means, but even the medical profession is willing to withdraw life from people when no chance of improvement is likely. I work with these people every day. It certainly is harrowing and stressful. I have many clients attempting to pick up the pieces after a loved one has taken their own life. I see both sides. It's ugly and raw and gut-wrenching for all involved, and not amenable to neat, squared-off policies.

Edit: this was in response to Macdoc.
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Re: Suicide and Bodily Autonomy

#22  Postby surreptitious57 » Oct 31, 2018 12:08 pm

I do in principle support anyone who wants to commit suicide as long as they are fully compos mentis
and the decision to do so is a logical one rather than an emotional one regardless of all other factors

I recently decided on a specific method of ending my own life should I ever feel suicidal again. Now unfortunately I can no longer put it into practice. However if I could then my suicide would be a logical decision taken when fully compos mentis which would make it morally justifiable. As a virtual loner I am not burdened by the emotional pain I would cause my loved ones were I to commit suicide. My decision would therefore be more clinical and easier to make. No one would miss me and
I would be going to a place free from suffering for evermore

But even where that was not the case I would still support suicide as a moral choice assuming compos mentis and logical decision once again. No one really knows what goes on inside someones head and if the unconditional love of family and friends is not enough to save someone from their particular private hell then nothing can as that is as powerful as it gets

But for me the eternally grey area is where someone is not compos mentis and the decision to take their life is an emotional not a logical one. Even more so given the fact that they would probably still want to do so when they are compos mentis and thinking logically or predominantly so. To that dilemma I have no answer beyond the usual display of sympathy and empathy

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Re: Suicide and Bodily Autonomy

#23  Postby Thomas Eshuis » Oct 31, 2018 12:19 pm

zulumoose wrote:
Fallible wrote:I mean, cancer is perfectly natural, but it's definitely an illness.


Not to go too far off topic here, but Cancer is a mutation, an invasion of the body by malignant cells from within.
It is only natural in the same way every disease is natural.

Not every disease is caused by outside cells, some are hereditary for example.
"Respect for personal beliefs = "I am going to tell you all what I think of YOU, but don't dare retort and tell what you think of ME because...it's my personal belief". Hmm. A bully's charter and no mistake."
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Re: Suicide and Bodily Autonomy

#24  Postby Thomas Eshuis » Oct 31, 2018 12:20 pm

Fallible wrote:I don't agree with your contention about cancer, but cancer was just an example. Pick any illness from thousands - they're mostly natural.

From my perspective, you're not describing severe depression in a coherent fashion. It is NOT a normal reaction to circumstances - that would be feeing appropriate emotions and then when the circumstances have passed, a lessening, and an expression of new emotions in accordance with the new circumstances. Severe depression is when one feels severe sadness, lack of motivation, suicidal ideation, etc. when these feelings are not in response to circumstances. It is an illness. Its causes are many, and not fully understood, but there are many illnesses which are not understood. That does not mean we can define them any way we like. Severe depression is always a sign that something has 'gone wrong' - but again, this is a pretty nebulous phrase which does not necessarily entail the gone-wrongness being to do with 'mind makeup' (yet another nebulous term).

This puts me in mind of how mental illness continues to be the poor relation of physical illness. People just seem to feel fine about making up their own explanations for what it is or how it is. This in turn can lead to judgement. This in turn can lead to those suffering being ashamed or embarrassed. I haven't seen you judge, but as can be seen by Macdoc's comments, it happens. People are dying from severe depression. Is that a perfectly natural and normal normal reaction?

:this:
"Respect for personal beliefs = "I am going to tell you all what I think of YOU, but don't dare retort and tell what you think of ME because...it's my personal belief". Hmm. A bully's charter and no mistake."
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Re: Suicide and Bodily Autonomy

#25  Postby Thomas Eshuis » Oct 31, 2018 12:29 pm

Macdoc wrote:Thomas
What a weirdly specific and graphic description. Are you unaware that multiple countries already allow assisted suicide?


Do you actually read anything I wrote ??

I quoted what you wrote. So if there's anything wrong with it's on you to improve.

Macdoc wrote:? or just knee jerk negative per usual?

A completely unwarranted and baseless personalisation.

Macdoc wrote:
This is what I wrote
We have assisted suicide for those with terminal illness and a panel of medical personnel to oversee that.
http://www.rationalskepticism.org/psych ... l#p2660038


In Canada it is a doctors duty of care to prevent self harm and there is guiding legislation as well supporting them.

Then I don't see how you can describe (assisted) suicide as causing a 'splatter'.

Macdoc wrote:
Clinical assessment

The guiding ethical principle underlying a clinical assessment where risk of self-harm is a central issue is beneficence. Even if the patient does not want to be in the ER or to be assessed by a physician concerning these matters, physicians have a duty to act in the patient's interest and preventing harm to self is considered on its face to be in the patient's interest.

This is actual a good read on the ethical dilemma that some cases present - part of the education series by the Royal College of Physicians and Surgeons of Canada,
http://www.royalcollege.ca/rcsite/bioet ... arm-self-e

From that article
Mental health legislation that permits involuntary assessment and hospitalization is informed by the common-law doctrine of parens patriae—the notion that the sovereign (or, in our case, the state) has the authority to protect persons from themselves.


So yes, here there is the notion that attempted suicide requires intervention by the state as an underlying principle,

Which does nothing to address the point I raised.

Macdoc wrote:From the same section and the heart of the question in this thread

there are authors who have argued that persons should never be forced into hospital against their will—that the right to self determination is always more important than any interest that society may have in protecting people from self-harm. In other words, the question of whether people should be involuntarily hospitalized is a classic conflict between the ethical principles of autonomy and beneficence (acting in someone else's best interest).

In Canada, from a public policy point of view, beneficence has been deemed to be more important than autonomy in cases where people are at risk of self-harm. This is because it is believed that self-harm generally occurs in the context of mental disorder, and mental disorder diminishes people's abilities to act autonomously.


That would be my stance and clearly the stance of the medical community here.

Which is still an appeal to tradition fallacy.

Macdoc wrote:The case study in the article raises good questions and provides insight into two different legislative approaches,

If it is based on this definition:
This is because it is believed that self-harm generally occurs in the context of mental disorder, and mental disorder diminishes people's abilities to act autonomously.

it is inherently circular and irrational.

Macdoc wrote:
Is Sarah's capacity to make treatment decisions relevant to decisions about intervening in situations of self-harm?

Sarah's capacity to make treatment decisions is not relevant to decisions about hospitalization, except in Saskatchewan. In Saskatchewan, a person has to be incapable of consenting or refusing treatment for the disorder that is leading to the involuntary admission.
In all other provinces, the decision about hospitalization is made on the basis of self-harming behaviour or threats of self-harming behaviour. This is regardless of the person's capacity to consent to or refuse treatment, even treatment for the very disorder that is leading to the admission.

Which is a rather vague use of the term 'self-harm'. If someone decides, of their own volition that they wish to stop living, how is that self-harm?

Macdoc wrote:
My first cousin's wife was involved as a career in suicide prevention and intervention and finally left the field due to the stress of dealing with such cases....both in dealing with the individuals attempting self harm and dealing with the damage to those close to the suicidal person.
No easy task.

Your anecdote is exactly as relevant and convincing as the anecdotes of people who work in assisted suicide and can tell you how both patients and their loved ones were relieved to choose assisted suicide.
Last edited by Thomas Eshuis on Oct 31, 2018 12:35 pm, edited 1 time in total.
"Respect for personal beliefs = "I am going to tell you all what I think of YOU, but don't dare retort and tell what you think of ME because...it's my personal belief". Hmm. A bully's charter and no mistake."
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Re: Suicide and Bodily Autonomy

#26  Postby hackenslash » Oct 31, 2018 12:33 pm

Macdoc wrote:It IS in the view of current society and the medical community.


On what basis? The only thing for which there are stats are people who don't complete or fail to. What's the evidence?

This is a beautiful combo fallacy, ad verecundiam and ad populum in spades. Until not too long ago, it was the view of society and the cosmology community that time and space began at the big bang, based on incomplete information. This situation is no different. Where are the data on the mental health of people who complete without warning, and how were they obtained?

I'd say you have to demonstrate it's not and is not harmful to society/others.


I'd say you have to ask yourself whether you'd apply this level of uncritical acceptance to anything else. This is a lovely commission of onus probandi.

By undertaking the act you absent yourself from censure and leave others to clean up the splatter. Toilet training generally occurs earlier.

How willing are you to harm others? :coffee:


Lovely argumentum ad consequentiam.

So, we've established now that your position is rooted in fallacy. Got anything more substantial?
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Re: Suicide and Bodily Autonomy

#27  Postby hackenslash » Oct 31, 2018 12:35 pm

laklak wrote:The question weighs on me. This Thursday will be the 10th anniversary of my Dad's suicide, and I've spent many nights wondering what I could or should have done, or if I had a right to intervene at all. He was 82, and was ill but not terminal. He had Type 2 diabetes, was on injectable insulin, and doing the finger stick thing. He'd had intestinal cancer but it was successfully treated by surgery alone. But he'd spent the last 5 (at least) years of his life sitting at the table watching the boats go by on the intracoastal waterway. He didn't have any friends, any hobbies, he couldn't eat what he wanted, drink what he wanted, and he was physically incapable of doing the things he had always kept very busy with. Rebuilding antique cars, crewing a racing sailboat, living and working all over the world - that constant activity was, I think, his way of dealing with the black dog, who had followed him his entire adult life. Back in the 60s they'd even done the whole electro-shock thing to him. To top it off, my mom (rest her, too) was a strong woman. "Formidable", as my brother-in-law said when he met her. With the best of intentions she cosseted him, and he wasn't the sort of man to resist. Whether his actions were a product of the goddamn black dog or a rational decision taken by a rational man, I'll never be sure. I think maybe a bit of both.

I've come to terms with it, certainly took a while and it wasn't an easy thing to forgive. No, not forgive, that's a stupid word. There's no forgiveness necessary, he did what he felt was the best thing. The only thing, actually, because once you decide on that course of action you've exhausted all other avenues. That's the rub. One man's "exhaust all other avenues" is another man's "you're giving up without a fight". If you judge someone because you perceive them as weak, or selfish, then maybe you have to forgive them to move on, but if you can accept that for whatever reason suicide was their only rational choice then no forgiveness is required, only understanding and sorrow.

My advice to anyone thinking about it, though, is leave a goddamn note and explain yourself. Don't let your family wonder.


Beautifully said. Thank you.
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Re: Suicide and Bodily Autonomy

#28  Postby Thomas Eshuis » Oct 31, 2018 12:36 pm

hackenslash wrote:
Macdoc wrote:It IS in the view of current society and the medical community.


On what basis? The only thing for which there are stats are people who don't complete or fail to. What's the evidence?

This is a beautiful combo fallacy, ad verecundiam and ad populum in spades. Until not too long ago, it was the view of society and the cosmology community that time and space began at the big bang, based on incomplete information.

Or more closely related to psychology; that homosexuality was a mental illness.
"Respect for personal beliefs = "I am going to tell you all what I think of YOU, but don't dare retort and tell what you think of ME because...it's my personal belief". Hmm. A bully's charter and no mistake."
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Re: Suicide and Bodily Autonomy

#29  Postby hackenslash » Oct 31, 2018 12:37 pm

scott1328 wrote:
hackenslash wrote:
Macdoc wrote:My take is that treatment should be mandatory as suicide attempts being a clear symptom of mental illness.


I'd love to see some flesh put on this assertion, because this is the question before us. Is suicide ideation/attempt/completion necessarily a symptom of mental illness?

I reject this claim as unsupported.

Is living better than not? Can this be demonstrated?

The problem is differentiating the cases of mental illness driven suicidal ideation from other causes. The presumption is for mental illness. The question you pose is not relevant (eta: because there is no verifiable way to make such an assessment). The question is do “mentally healthy people commit suicide?”


That's the same question recast. My question gets to the nub of it, because it shows that the answer to the question is entirely subjective. If there's no verifiable way to make an assessment, it becomes and unfalsifiable proposition, and medical science has to say that this is beyond its remit.

In my opinion, the answer to your question is 'yes, they do'. This is not a robust conclusion, however, which I freely admit.
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Re: Suicide and Bodily Autonomy

#30  Postby hackenslash » Oct 31, 2018 12:41 pm

Macdoc wrote:Society and medical say no which I tend to agree with.


Irrelevant and fallacious. I already exposed the fallacies here. The opinions of society and medicine are irrelevant unless they have data. There are none.

From a social perspective ...there is always harm.


I'd argue that the greater harm is in non-acceptance, because it discourages those who really could be helped from reaching out.

Even bringing up the harm to society discourages this. See the second post I linked to.

From a personal perspective ....in some cases relief from present pain or known future pain ( certain cancers or conditions ) certainly can be supported.


What about psychic pain driven by purely practical things?

In a healthy person ..nah..but then self destructive behaviour is nothing new.


That's just an assertion. Care to put some flesh on it?
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Re: Suicide and Bodily Autonomy

#31  Postby hackenslash » Oct 31, 2018 12:42 pm

Fallible wrote:I mean, cancer is perfectly natural, but it's definitely an illness.

On Macdoc's point there, I'm not really sure what he means by absenting yourself from censure. On his second point, although people suffer greatly from losing a loved one to suicide, too much sorrow is caused in this world by putting others' needs and feelings before one's own. No one should be forced to suffer through hell because others will be affected if they go. Additionally, having heard the reasoning behind people's desire to end their own lives, a very common thought is that loved ones will be much better off without them. Sure they'll be sad, but they'll get over it in time. They think they're actually doing the best thing for the ones who will be left behind - it's not a clearly selfish act at all.


Bingo. I talk about this at some length in the second of those posts.
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Re: Suicide and Bodily Autonomy

#32  Postby hackenslash » Oct 31, 2018 12:43 pm

zulumoose wrote:
I'd love to see some flesh put on this assertion, because this is the question before us. Is suicide ideation/attempt/completion necessarily a symptom of mental illness?


I would say it usually is, if you define severe depression as mental illness, which I don't. It is helpful to put that label on it in a medical sense, but I think severe depression can be perfectly natural and not something to be treated as such, so the label is a bit of a poor fit in my view.
It is of course not NECESSARILY so, since one can make a clear and logical choice that your life is complete and tomorrow is just going to be a burden, perhaps to others as well as to yourself.


By undertaking the act you absent yourself from censure and leave others to clean up the splatter. Toilet training generally occurs earlier.


I hope this was intended differently to how it appears to me, which is a callous dismissal of suicidal people and a horrible misunderstanding of what their reality can be at the time.

When seriously considering suicide the rest of the world can be completely irrelevant, "others" can be just part of the reality that has rejected you, your ties to those you cared about can seem absolutely false and meaningless. Concern for those left behind would be a recognition of a future that does not exist in your reality. Don't make the mistake of believing that someone on the brink of suicide is thinking in a way that you would recognise and could relate to or judge. It is fantastically unhelpful and wrong to judge suicide as an act of selfishness or cowardice, since at the time those concepts can be completely meaningless.


Yes.
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Re: Suicide and Bodily Autonomy

#33  Postby hackenslash » Oct 31, 2018 12:45 pm

zulumoose wrote:
Fallible wrote:I mean, cancer is perfectly natural, but it's definitely an illness.


Not to go too far off topic here, but Cancer is a mutation, an invasion of the body by malignant cells from within.
It is only natural in the same way every disease is natural.

From my perspective (and I am not trying to force it on others, it is just my view) depression is more like going into shock, which can be fatal, and can be treated, but is often a natural and normal reaction to circumstances, and not always a sign that something is wrong with the body/mind makeup. Shock can be fatal but is not an illness. Cancer (although internal) definitely means something has gone wrong.


Not all suicides are the result of depression.

BTW, apoptosis failure is entirely natural.
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Re: Suicide and Bodily Autonomy

#34  Postby hackenslash » Oct 31, 2018 12:49 pm

Macdoc wrote:From the same section and the heart of the question in this thread


there are authors who have argued that persons should never be forced into hospital against their will—that the right to self determination is always more important than any interest that society may have in protecting people from self-harm. In other words, the question of whether people should be involuntarily hospitalized is a classic conflict between the ethical principles of autonomy and beneficence (acting in someone else's best interest).

In Canada, from a public policy point of view, beneficence has been deemed to be more important than autonomy in cases where people are at risk of self-harm. This is because it is believed that self-harm generally occurs in the context of mental disorder, and mental disorder diminishes people's abilities to act autonomously.
[/quote]

Even the language there exposes the underlying assumption, which stands unsupported by ANY data. Talking about 'risk of self-harm' casts suicide as being counter to the interests of the patient, based entirely on the notion that living is better than not, an unjustified assumption.

Really not interested in the law, because that's based on the unsupported assumption. That assumption is what I'd like to see justified, and nobody has made any inroads into that at all.
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Re: Suicide and Bodily Autonomy

#35  Postby hackenslash » Oct 31, 2018 12:51 pm

Fallible wrote:In other arenas, autonomy is considered the most important thing. That doesn't mean there are no 'speed bumps'. I don't think I can recall any time at which I told a person to go right ahead and kill themselves the first time they expressed to me their desire to do so. The process often spans weeks of intricate discussion and proposal of alternatives, analysed one by one. Still at the end of that process, a small number will clearly and rationally state that their choice is still the same. Protect mentally ill people from themselves by all means, but even the medical profession is willing to withdraw life from people when no chance of improvement is likely. I work with these people every day. It certainly is harrowing and stressful. I have many clients attempting to pick up the pieces after a loved one has taken their own life. I see both sides. It's ugly and raw and gut-wrenching for all involved, and not amenable to neat, squared-off policies.


Indeed, because grief is always self-centred. There are no easy solutions, yet we treat the situation for the most part as if we already have them.
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Re: Suicide and Bodily Autonomy

#36  Postby surreptitious57 » Oct 31, 2018 12:53 pm

Fallible wrote:
This puts me in mind of how mental illness continues to be the poor relation of physical illness

A broken or damaged mind can be far more harmful than a broken or damaged body but the body sufferers probably
still get the most sympathy when it should be given equally to everyone.The notion that those with damaged minds
will be able to pull out of it if they apply sufficient willpower is ignorance of the highest order. The reason they are
called demons is because they control you not you them
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Re: Suicide and Bodily Autonomy

#37  Postby hackenslash » Oct 31, 2018 12:58 pm

In fact, the reason they're called demons is that mental disorders were one thought to be caused by literal demonic possession, such as Jeebus cast out into the suicidal pigs.

One of the worst things you can say to somebody in pain is 'well, you look alright'. As somebody with chronic back pain that only manifests outwardly in my expression, I get this all the time. To do this to somebody with depression or any other mental or emotional conditions is even worse, and this is part of the attitude I'm out to change.
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Re: Suicide and Bodily Autonomy

#38  Postby Thomas Eshuis » Oct 31, 2018 1:05 pm

hackenslash wrote:In fact, the reason they're called demons is that mental disorders were one thought to be caused by literal demonic possession, such as Jeebus cast out into the suicidal pigs.

One of the worst things you can say to somebody in pain is 'well, you look alright'.

I hate that.
My mother especially seems to think that as long as I don't say anything or am not curled up on the couch, I'm fine.
I've been wanting to have a serious discussion with her about my situation, but the last two times I tried, she kept projecting her own assumptions on me and in general did not seem to grasp how serious it is.

hackenslash wrote: As somebody with chronic back pain that only manifests outwardly in my expression, I get this all the time. To do this to somebody with depression or any other mental or emotional conditions is even worse, and this is part of the attitude I'm out to change.

:thumbup:
"Respect for personal beliefs = "I am going to tell you all what I think of YOU, but don't dare retort and tell what you think of ME because...it's my personal belief". Hmm. A bully's charter and no mistake."
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Re: Suicide and Bodily Autonomy

#39  Postby surreptitious57 » Oct 31, 2018 1:17 pm

I think it says something about how society is more concerned with only what it actually sees. We are getting better but the
prejudice and ignorance sadly still remain. As with many things education is the answer even if it is wasted on closed minds

I think it is a grey area regarding telling sufferers how well they look because it is probably meant with good intention
Of course how they look is irrelevant as it is how they feel that really matters. But for the observer the emphasis is on
the outside not the inside. Some education in that area is needed too
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Re: Suicide and Bodily Autonomy

#40  Postby Evolving » Oct 31, 2018 1:18 pm

A friend remarked recently à propos of a mutual acquaintance who has repeatedly said (not to me) that she doesn't want to live: why not tell her, ok, go on and do it? Who are we to say you have to carry on suffering?

I don't want to agree, but it's very hard to argue against it (hence this thread, I suppose).

I wish I had something more useful to contribute to this discussion.
How extremely stupid not to have thought of that - T.H. Huxley
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