[Warning] Morality of mortality

[TheEllipticalDisillusion]

I put [warning] in the title, so that people who are uncomfortable with the topic can avoid it. If you are uncomfortable, I request that you do not participate in the thread. I'm not trying to dictate where people spend their energy, but I'd like to see where the discussion will take us. I don't have any shocking opinions that I am trying to get away with (I don't necessarily think that far in advance--I mostly go with the flow). And if at any time you feel uncomfortable during the discussion, just indicate that and bow out (no shame in leaving a discussion that stirs your emotions negatively).

Anyway...





In the range of moral and rational issues: where does suicide and death fall? We outlaw suicide in the US and go so far as to lock people into wards if they exhibit suicidal thoughts. The human mind desires self-preservation, but what about those minds that have convinced themselves that this is not a worthy goal? Is suicide right (for some)? Can you rationalize suicide?

Speaking of death: where does the issue of condemning others to death fall? Clearly, it's a moral issue, but what does that say of it? Is it wrong to condemn a murderer to die by some means? Is it wrong to condemn him to die slowly in a jail cell? Is self-defense that results in death right or wrong (or neither)? Do we as a society that punishes some to die by our hand (metaphorically speaking), have a leg to stand on when it comes to telling individuals that they may not die by their own?

Some considerations: Suicide is/was an honorable form of self-punishment in Japanese feudal society. Suicide was regularly employed in the works of Shakespeare and Sophocles (Antigone, Haimon and Eurydice). I'm not offering these as right or wrong, just as considerations of differing views in different times and cultures.

Last note: I am not, nor have I ever been suicidal, so this isn't a secret cry for help, but I have been trying to channel my discussion energy into topics that I used to discuss.

[sauronsfinger]

For some persons, suicide may be the most rational course of action. People of relatively sound mind should have that option. In fact, they do right now through such things as DNR orders in hospitals but that is the dirty little secret of health care.

You are correct that such things are highly cultural and change radically in view from one society to another and from one era of history to another.

TED - I know you are not suicidal or mentally disturbed although that urge to be a NY Islanders fan should be looked into.

[Primula Baggins]

Suicide by prescription is legal in Oregon, if you're within six months of death by sound medical opinion and if you're in your right mind. This would exclude people who simply want to die, and that's a good exclusion.

A DNR (do not resuscitate) order is not the same as suicide, nor is it a "dirty little secret." It's very common, just because technology otherwise allows the dying process to be stretched out over days or weeks without in the end changing anything. If people choose not to be messed with in that way, or to allow their comatose family members to be messed with, that is not suicide or murder. It's ethical and it has always (I imagine) been done.

But suicide when one could be helped, healed, and live a productive and worthwhile life is comparable to murder. Our lives don't belong just to us. Real suicides take a terrible toll on the survivors.

[sauronsfinger]

Prim - by "dirty little secret" what I meant is that for many people it is indeed a secret. I know many people who only found about this option until a loved one was in the hospital near the end. There are whole lots of people who do not know about this until it enters their own lives. For them, it is a secret.

Our lives don't belong just to us.

But who else is over each of us? I think that for some persons, suicide may be a viable option to the life they lead. Who are we to judge?

[axordil]

Is the pain of being a survivor when someone we know commits suicide a cultural construct?

[Primula Baggins]

I hope not!

[axordil]

Is that response a cultural construct?

Not being flippant here, though it sounds like it. I would certainly expect that a sense of loss would follow the death of anyone close to us, and I think that's transcultural. However, the question for me is whether other cultural considerations can outweigh that sense of loss. I can think of some that apply even in our culture: the lionization of first responders and soldiers who fall "in the line of duty" culminates with the honor accorded those who sacrifice themselves to save others.

[Primula Baggins]

I don't think you were being flip, Ax. I wasn't either; that was a gut reaction and a strong one.

People who sacrifice themselves to save others are not committing a negative act. They're doing their duty and to some degree, often a very large one, are generous and brave. We admire all those things. But it's not because their own actions resulted in their own deaths; it's because they did dangerous and necessary things to help other people, in spite of the fact that their actions endangered their own lives.

Of course their loved ones will still feel a sense of loss, maybe a terrible one. But at some point, possibly, the fact that their deaths meant something, were not purposeless, might offer some comfort to the people left behind.

Suicide, from what I've learned from knowing family members of people who committed suicide, is the opposite. You have the grief of the death, but the more you contemplate how it happened, the more you feel guilt at having failed the person (whether or not you did), anger at the person's selfishness, and grief over the waste. The circumstances make it worse.

[River]

There was a time, in the past, when I wanted to kill myself. I really thought I was the utterly worthless and useless and selfish and terrible person my boyfriend at the time wanted me to think I was. One night, I was truly ready to do it, to jump off a nearby bridge. Except I was also on duty with the campus rescue squad, and I had an obligation to respond to any calls that came in over my radio. I wouldn't be able to do that from the bottom of the river. Around the time I realized that, I also realized how fundamentally irrational my thinking was. Chalk one up for my self-preservation instincts, I guess. But, having been in that place, I have some insight: it is not rational. No healthy person logically concludes that they should die. Not when there really are viable alternatives. Not when all there is to lose is your life. The soldier who throws themself on a grenade to save their buddies, the captive who takes cyanide to avoid spilling secrets to an enemy, and other heroic cases are different. There are times when you can serve a greater good by dying, but those times and situations are rare. Your life not going as planned, or you believing yourself to be worthless, are not in that category.

This fundamentally irrationality, this sickness at the heart of your ordinary suicide, is why it is considered immoral. Not only do you throw your own life away, you leave a void in the lives left behind. That void is never going to be re-filled.

It honestly took me a long time to figure that last bit out. I used to wonder if it was right to intervene on a suicide. I wondered that even while I was an EMT treating attempted suicides. I wondered that even when I got my ex-boyfriend (the guy who had me almost convinced I should die) committed because he was suicidal. His former best friend took part in that as well. Didn't he have a right to be irrational? I struggled with that. His friend saw it more clear cut - you don't have a right to hurt yourself because you're never hurting just yourself. In the end I acted mainly because, my general rule when faced with that kind of decision is to take the choice that is revocable. That is to say, I wasn't sure if I should step in or not, but I was pretty sure that if I didn't he'd jump as planned. Whereas if I did step in, he'd get treated, the treatment would or wouldn't take, and he'd live to make new choices and new decisions. He was very angry at me. For years. This happened in 2003. I've been getting e-mails intermittently since then. In the first year after the event, they were frequent and angry. Then I told him to leave me alone and stopped responding. They were less frequent but no less angry. He accused me, of, among other things, saving his life because I wanted to see him miserable.

Actually, I didn't want to see him at all. Even then. I just acted because, along with his friend, we were the only ones who could.

Anyway, I recently got an e-mail from him stating that for years he'd been trying to prove me wrong, to prove that he should have died that day in 2003. If at any point I'd told him, in so many words, to just go die he probably would have (and I admit I knew that, which is why I didn't do it). But now, apparently, he's starting to see a future for himself and so he's going swallow his pride and live. He's a fantastically bad writer, but I think that's what he meant. Amusingly enough, he somehow took a tone that suggested he wanted to hurt me in that e-mail: "F*** you b****, I'm going to live!" or something like that. Which is really all I ever wanted for him.

The frightening thing was, as with my case, there was a fundamental gap in his logic as to why he should die. But he was convinced that his reasoning was sound. He couldn't believe it wasn't. And, as I said before I decided to tell this story, that's where the sickness lies and that's why suicide is generally regarded as wrong.

End of life decisions are something else. I've something to say about tha too, but I've gotta get back to work.

[Maria]

Everybody dies. Every death is going to hurt the friends of those left behind. It's part of being human.

edit: I mean, being human means making connections and when those connections are ripped away, it hurts.

[axordil]

But at some point, possibly, the fact that their deaths meant something, were not purposeless, might offer some comfort to the people left behind.

There are societies in which less altruistic forms of suicide are thought to have purpose as well. What I'm saying is that in both cases, there's a cultural determination as to the value of the action, which can either amplify or balance the natural sense of loss.

[JewelSong]

Prim - by "dirty little secret" what I meant is that for many people it is indeed a secret. I know many people who only found about this option until a loved one was in the hospital near the end. There are whole lots of people who do not know about this until it enters their own lives. For them, it is a secret.

A DNR (Do Not Resusitate) is certainly not a secret. It is a standard option when someone is in a state of dying or near dying. Of course you wouldn't necessarily know about it until you needed it. I don't know a lot about certain cancer treatments but if I had a particular kind of cancer, I would be informed.

A DNR is not any kind of "secret" - when you or a loved one is in the situation, you are told about it. Being told is standard procedure - nothing is hidden. And anyone who has had a loved one in that kind of circumstance (hell, anyone who has watched even one episode of any medical program,) would know about it.

And why you would call it a "dirty" little secret is beyond me. It is a standard, well-known medical option which is fully out in the open.

[sauronsfinger]

from Jewelsong

And why you would call it a "dirty" little secret is beyond me.

Why you would not understand is beyond me since I already explained it. But, for you, here is some more.

Medical science has this reputation for preserving life. We tend to believe that doctors and hospitals are going to do everything possible to preserve that life. At least that is the storyline put forward by the medical profession for a long time now. If one has little contact with the medical system and does not keep up with it, for many people, the first time they find out about a DNR is when it is presented as an option when a family member is near death.

I can say this for a definite fact because it has happened within my family and I have friends who I have discussed this with and have had the same experience.

It is not publicized. It certainly is not part of a hospitals ad campaign. The first many people hear of it is when they are confronted with the reality of it and it often seems jarring that it conflicts with the image of the medical profession that they have.

[Primula Baggins]

But it's a choice. There is no pressure (if there is, it's highly unethical). You can say, and some people do say, "No, do everything you can possibly do to save me" (or "Uncle Ernie"). And they will.

Medical professionals have, literally, a duty toward the patient, and part of that duty is honoring the patient's expressed wishes regarding his own care.

[River]

You understand what Do Not Resuscitate means right? It basically means they're going to let a dead person stay dead. Like, there's no life left to preserve. When a DNR order is signed, medical personnel have permission to let you be dead without arguing the point.

The act of resuscitation, the physical act of doing it, or attempting it, is literally an act of violence upon a corpse. You are, quite bluntly, trying to beat and shock a dead body back to life. Movies and pop culture in general like to sanitize this. You don't hear ribs popping in the movies. The body doesn't jolt. You don't hear the agonal breathing. ET tubes don't creep out of throats, IV lines don't pop out of veins, stomachs don't bloat and no one is frantically trying keep their balance in the back of an ambulance (you have to be a giant to reach hte patient's chest formthe "CPR seat"). In the movies, there's no such thing as an unshockable rhythm, the defib always works even there's a flat line, and they don't even look dead. Seriously. People who aren't breathing change colors very quickly and they turn blue. There is a reason why, at hospitals, they send family out of the room.

And the thing is, even when resuscitation works, only 10% of the survivors make a full recovery. The rest sustain neurological damage. Some only survive to crash again and again and again, until finally they just don't come back (this is why my grandfather signed a DNR on my grandmother). I've also seen DNRs tacked on fridges in people's homes. Honestly, when it comes to someone who's already dead (I am most emphatically not talking about treatments that extend life in the already living; that's a whole other kettle of fish), is it right and moral to subvert nature at all?

Modern American culture doesn't like dealing with death. We hate facing our own mortality. We have a hard time talking about it, talking about what's realistic and what can be expected. Everything that lives dies. This is a constant of biology. Modern medicine can push that inevitability ahead into the future, but at some point bodies just fail. Signing a DNR is just an acknowledgement of that.

[sauronsfinger]

from River

You understand what Do Not Resuscitate means right? It basically means they're going to let a dead person stay dead. Like, there's no life left to preserve.

I am just a layperson who is outside of the medical profession. I only know about this from the two family cases I was involved in personally. in both cases, the forms we signed, went beyond the idea of letting a dead person stay dead. They stopped treatment. They stopped giving drugs and medicine except that for pain relief. They did not take any action to reverse the situation when the physical condition deteriorated and death approached. They would have done otherwise had those orders not have been signed by the family.

It was not merely a matter of letting the dead stay dead. It was allowing the person to remain in the hospital and take the day or two or three that they needed to die.

[Primula Baggins]

But the DNR doesn't deal with that. As River says, it just deals with what happens after the person dies.

Stopping treatment is a separate issue, but that's not suicide either. When death is coming, people can reach a point where they're just too tired to want to go on fighting—especially since "fighting" may involve taking drugs that make them sick or unable to communicate easily with loved ones.

Sometimes people decide it's time to just be as comfortable as they can be and with the people they love for as long as life remains. It's increasingly common for people to go home from the hospital for their last days, usually with hospice help to make sure they are not in pain and that the patient and family have emotional support. That's effectively a DNR order; when death comes, nobody can or will intervene.

[vison]

When my Dad was dying (at home) his doctor showed the form to my Mum, discussed it with her, and Mum signed it. No secret, no "pressure", no nothing. The doctor explained that when Dad died, the police did not need to be called, nor any other emergency service. Only the undertaker, and they would come at any time, day or night.

It happened that my dear sister-in-law was sitting with Dad when the end came. She knew his death was momentary, and called Mum and me and my sisters to his bedside.

[JewelSong]

he two family cases I was involved in personally. in both cases, the forms we signed, went beyond the idea of letting a dead person stay dead. They stopped treatment. They stopped giving drugs and medicine except that for pain relief. They did not take any action to reverse the situation when the physical condition deteriorated and death approached. They would have done otherwise had those orders not have been signed by the family.

This is not a DNR. This is a different kind of order, a bit more complex. It might be called "Palliative care only" -in other words, simply keep the patient comfortable and pain-free. It means that the patient has declined any further aggressive or invasive treatment.

Again, this is a choice for ALL patients and yes, it is a choice that you are confronted with when you or a family member is near death or in extreme circumstances. Treatment can be refused. Treatment can always be refused, and often is, at the end stages of cancer or some other wasting and horrible disease.

You may not have known this previously, but calling it a "secret" implies that it is deliberately withheld and calling it "dirty" implies that the medical profession is doing something wrong. Neither is true.

It happened that my dear sister-in-law was sitting with Dad when the end came. She knew his death was momentary, and called Mum and me and my sisters to his bedside.

vison, my own dear mother spent her last days at home, under the 24-hour care of two hospice nurses who seemed literally like angels from heaven. When my Mom started to slip away in the early hours of the morning, the nurse called me and woke my father and we were able to sit with her and hold her hands as she peacefully died.

[TheEllipticalDisillusion]

I think the preparation for loss is the difference between the DNR and suicide. If someone signs a DNR, they have to be in a certain state for it to be enacted, unlike suicide where the loss comes a bit more sudden.

We say that everyone has a right to life in our society, but no right death. In some respects this right to life isn't individual, but social. We as the society have the right to your continued life, we as the family have this right, we as the friend have this right.... society also claims the right to death. Murder is punished, but dying in war isn't.