![]() Was it a carefully considered suicide or was it rash? Did the individual feel in control or powerless? Was the choice based in self-respect, self-care, and self-love, or was it based in fear, despair, or anger? There is a world of difference between a distraught teenager bullied into suicide and an individual with a chronic or terminal illness who, after careful deliberation, decides to die rather than suffer through what the future most likely holds. Specifically, it tells us nothing about how the choice was made. That people commit suicide tells us nothing about their choices. From the emotionally distraught who cannot see past their current situation to samurai who have brought dishonor upon their station, from sufferers of psychosis whose inner voices drive them to destruction to those elderly who have reached the extent of the limitations they wish to live with, from the condemned who take the blade rather than have another do the deed to those suffering from chronic pain, from widows whose society calls on them to die upon their husbands’ funeral pyres to Antarctic explorers who wish to give their comrades a better chance of survival, from toppled monarchs with no safe path to exile to individuals facing a terminal illness … all these are faces of suicide. ![]() The act of suicide is as diverse as the people who choose it. It provides no information about the reason(s) life-expectancy physical, mental, or emotional state morality legality or anything else one might want to layer on top of this beleaguered word. There is a need to rehabilitate the concept of “suicide.” Suicide means to intentionally end one’s own life. That said, the decades-long struggle of the death-with-dignity movement is clear evidence that even when individuals are explicit about what they want, society and the medical community have been largely unwilling to loosen their grip on that default framework and empower individuals to more actively shape when and how their lives end. Where individuals haven’t made explicit what they want, caregivers and medical personnel need a default framework from which to operate. Those who do not choose will have society choose for them, and society’s default is to preserve life regardless of its quality. ![]() Those with chronic or terminal conditions face a similar situation. Without conscious, assertive preparation, and action, individuals whose quality of life ends before their life does will simply be moved, mindlessly, through the standard stages of care. Having visited both my grandparents’ and now my parents’ generations in nursing homes, living as they would not have wanted to live, it has become clear that avoiding these kinds of endings is not easy. In single-mindedly pursuing the preservation of life as the holy grail of medicine and considering quality only within that framework, we lose sight of the human experience in each life we cease to care for the person and instead care for the body.īe it denial or simply discomfort, our willful blindness to the reality of death (our own and that of others) leaves us exposed, unprepared to actively shape this important and inevitable transition from our lives. For some of us, there is a period of suffering or indignity at the end of our lives: an unhappy twig that if we could stand back and cultivate our lives like a gardener, we would trim off to shape our lifetimes to our own priorities and values. In denying that this point exists, we fail to plan for it, both practically and emotionally, and the price of our failure is that some of us are continuing to live when we no longer want to. We seem to be in collective denial that there is a point at which our current tools are inadequate to preserve an acceptable quality of life, howsoever we define that for ourselves. Though increasing levels of debilitation are shifted later and later in life, they will come, and we, as individuals and as a society, are remarkably ill-prepared to handle that eventuality. Medical technologies are impressive at keeping these limitations at bay, but time marches on. Even before forty, that slow but steady physical and mental decline is making itself at home in our hair, our skin, our eyes, our joints, and, yes, our brains. Every blessing has its cost, however, and longevity is no exception. ![]() At forty, we have not yet entered middle age, while at the dawn of the nineteenth century that would have been our life expectancy. Modern medicine has doubled American life expectancy over the past two centuries. Death is not a question of if it is only a question of when and how. It’s time to look beneath the stigma and see a socially-accepted role for suicide in a nation where our lives are our own. ![]()
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