"The proper role of government is exactly what John Stuart Mill said in the middle of the 19th century in his essay, 'On Liberty': The proper role of government is to prevent other people from harming you. Government, he said, never has any right to interfere with an individual for that individual's own good." Milton Friedman, Ph.D., a world-renowned economist and winner of the 1976 Nobel Memorial Prize in Economic Sciences, "Milton Friedman — End The Drug War" (1991), YouTube.com at 7:48.
Thinking about suicide is commonplace. In his book Suicide, published in 1988, Earl A. Grollman says "Almost everybody at one time or another contemplates suicide" (Second Edition, Beacon Press, p. 2). In his book Suicide: The Forever Decision, published in 1987, psychologist Paul G. Quinnett, Ph.D., says "Research has shown that a substantial majority of people have considered suicide at one time in their lives, and I mean considered it seriously" (Continuum, p. 12). Nevertheless, thinking about suicide is generally speaking frowned upon and by itself is enough to result in involuntary "hospitalization" and so-called treatment in a psychiatric "hospital", particularly if the person in question thinks about suicide seriously and refuses (so-called) outpatient psychotherapy to get this thinking changed. The fact that people are incarcerated in America for thinking and talking about suicide implies that despite what the U.S. Constitution says about free speech, and despite claims Americans often make about America being a free country, many if not most Americans do not really believe in freedom of thought and speech—in addition to rejecting an individual's right to commit suicide.
In contrast, the assertion that people have a right to not only think about but to commit suicide has been made by many people who believe in individual freedom. In his book Suicide in America (W. W. Norton & Co. 1982, p. 209), psychiatrist Herbert Hendin, M.D., says this:
Partly as a response to the failure of suicide prevention, partly in reaction to commitment abuses, and perhaps mainly in the spirit of accepting anything that does not physically harm anyone else, we see suicide increasingly advocated as a fundamental human right. Many such advocates deplore all attempts to prevent suicide as an interference with that right. It is a position succinctly expressed by Nietzsche when he wrote, "There is a certain right by which we may deprive a man of life, but none by which we may deprive him of death." Taken from its social and psychological context, suicide is regarded by some purely as an issue of personal freedom.
In his book The Death of Psychiatry, published in 1974, psychiatrist E. Fuller Torrey, M.D., said this: "It should not be possible to confine people against their wills in mental 'hospitals.' ... This implies that people have the right to kill themselves if they wish. I believe this is so" (Chilton Book Co., p. 180). In 1968 in his book Why Suicide?, Dr. Eustace Chesser, a psychologist, asserted: "The right to choose one's time and manner of death seems to me unassailable. ... In my opinion the right to die is the last and greatest human freedom" (Arrow Books, London, pp. 123 & 125). In On Suicide, published in 1851, Arthur Schopenhauer said: "There is nothing in the world to which every man has a more unassailable title than to his own life and person" (H. L. Mencken, A New Dictionary of Quotations, Knopf 1942, p. 1161). In a books-on-tape audiocassette version of their book Life 101, published in 1990, John-Roger and Peter McWilliams tell us: "The consistency of descriptions from a broad range of individuals points to the possibility that death might not be so bad. ... Suicide is always an option. It is sometimes what makes life bearable. Knowing we don't absolutely have to be here can make being here a little easier." Suzy Szasz (daughter of psychiatry professor Thomas S. Szasz), a victim of Systemic Lupus Erythematosus, confirms this view in her book Living With It: Why You Don't Have To Be Healthy To Be Happy after an acute flare-up of her disease during which she contemplated suicide: "As many an ancient philosopher has noted, I found the very freedom to commit suicide liberating" (Prometheus Books 1991, p. 226). In ancient times (circa 485-425 B.C.), Herodotus wrote: "When life is so burdensome death has become for man a sought after refuge." In his book The Untamed Tongue, published in 1990, psychiatrist Thomas Szasz asserts: "Suicide is a fundamental human right. ...society does not have the moral right to interfere, by force, with a person's decision to commit this act" (Open Court Publishing Co., p. 250-251).
To these statements of support for the right to commit suicide, I will add my own: In a truly free society, you own your life, and your only obligation is to respect the rights of others. I believe everyone is entitled to be treated as the sole owner of himself or herself and of his or her own life. Accordingly, I think a person who commits suicide is well within his or her rights in doing so provided he or she does so privately and without jeopardizing the physical safety of others. Family members, police officers, judges, and "therapists" who interfere with a person's decision to end his or her own life are violating that person's human rights. The often expressed view that the possibility of suicide justifies psychiatric treatment even if it must be imposed against the will of the potentially suicidal person is wrong. Provided the person in question is not violating the rights of others, that person's autonomy is of more value than enforcement of what other people consider rational or of what other people think is in a person's best interests. In a free society where self-ownership is recognized, "dangerousness to oneself" is irrelevant. In the words of the title of a movie starring Richard Dreyfuss: "Whose Life Is It, Anyway?" The greatest human right is the right of self-ownership, one aspect of which is the right to life, but another aspect of which is the right to end one's own life. Whether or not a person supports the right to commit suicide is a litmus test of whether or not that person truly believes in self-ownership and the individual freedom that comes with it, the individual freedom that many of us have been taught is the reason-for-being of American democracy.
One reason some oppose the right to commit suicide is theological belief that is sometimes expressed this way: "God gave you life, and only God has the right to take life from you." Using this reasoning to justify interfering with a person's right to commit suicide is imposing religious beliefs on people who may not share those beliefs. In a country such as the United States of America where we supposedly have freedom of (and from) religion, this is wrong.
Another reason some people believe it is ethical to interfere with a person's right to think about or commit suicide is belief in mental illness. But a so-called diagnosis of "mental illness" is a value judgment about a person's thinking or behavior, not a diagnosis of bona fide brain disease. So-called mental illness does not deprive people of free will, but on the contrary is an expression of free will (which reaps the disapproval of others). Those who say mental illness destroys "meaningful" free will or who call the beliefs of others irrational (and therefore necessarily caused by mental illness) are accepting the idea of mental illness as brain disease without adequate evidence or are refusing to accept the beliefs of others only because they differ from their own.
Sometimes people oppose the right to commit suicide because of belief in a sort of entirely non-biological mental illness. The error of this way of thinking is that without a biological abnormality the only possible defining characteristic of mental illness is disapproval of some aspect of a person's mentality or thinking. But in a free society, it shouldn't matter if the thinking of a person meets with the disapproval of others, provided the person's actions do not violate the rights of others.
Furthermore, there isn't any good evidence that mental illness by any generally accepted definition is usually involved in a person's decision to commit suicide. In her book about teenage suicide, Marion Crook, B.Sc.N., says "teens considering suicide are not necessarily mentally disturbed. In fact, they are rarely mentally disturbed" (Every Parent's Guide To Understanding Teenagers & Suicide, Int'l Self-Counsel Press Ltd., Vancouver, 1988, p. 10). Psychologist Paul G. Quinnett, Ph.D., makes this observation in his book Suicide: The Forever Decision (pp. 11-12):
As we have already discussed, however, you do not have to be mentally ill to take your own life. In fact, most people who do commit suicide are not legally 'insane.' So it seems we have a very interesting problem. To prevent you from killing yourself, doctors like myself will stand up in court and say something to the effect that, by reason of a mental illness, you are a danger to yourself and need treatment. But—and this is the weird part—you may, in a matter of a few hours to a couple of days, get up one morning and say, "I've decided not to kill myself, after all." And if you can convince us you mean what you say, you can leave the hospital and go home. Question: Are you now completely cured of your so-called mental illness? Obviously not, since the chances are you were never 'mentally ill' in the first place. ... As I have said, I do not believe you have to be mentally ill to think about suicide.
Dr. Quinnett's statement is a clear admission that allegations of mental illness to justify incarcerating suicidal people often are conscious, deliberate dishonesty, even by the definition of mental illness that exists in the minds of the professionals who make the allegations of mental illness. They make these allegations of mental illness even though they know they are false because involuntary psychiatric commitment laws require a finding of "mental illness" before involuntary commitment may take place. Making deliberately false accusations of "mental illness" under oath in a court of law to satisfy commitment laws for the purpose of discouraging suicidal thinking or preventing suicide is a way to avoid coming to terms with the fact that incarcerating people only because they happen to think their lives are not worth living or because they have attempted to end their own lives is a form of authoritarianism and despotism. In the case of people who have only thought about (not attempted) suicide, it is imprisonment for mere thought-crime similar to that illustrated by George Orwell in his novel 1984.
Even people who oppose the right to commit suicide because of their belief in mental illness sometimes can be made to understand the erroneousness of their biological theorizing or their belief in some kind of non-biological mental illness by asking them if they would see any point in living if they were suffering from a terminal disease involving excruciating, unrelievable physical pain or were completely paralyzed from the neck down with no chance of recovery. Once people admit there are any circumstances in which they would choose death, they often see suicide is the result of a person's personal judgment about his or her circumstances in life rather than a biological malfunction of the brain or some conception of non-biological mental illness.
Some may feel it is right to use force to prevent suicide because of their belief that the potentially suicidal person's desire to die is probably temporary and will probably go away or subside if he or she is forced to live a short time longer until the acute emotional reaction to a recent traumatic event has faded with time. Those advancing this argument sometimes acknowledge a person does have a right to commit suicide if he or she is not acting impulsively. But most evidence indicates few if any people who commit suicide do so impulsively. As Earl A. Grollman says in his book Suicide (in which he opposes the right to commit suicide): "Suicide does not occur suddenly, impulsively, unpredictably" (p. 63). In his book Suicide: The Forever Decision, psychologist Paul G. Quinnett, Ph.D., says: "I have talked to hundreds of suicidal people... If I can make another guess about what has been going on inside your head and heart, it is that you have had long and difficult discussions with yourself about whether to live or die" (pp. 18-19). In a July 6, 2011 Psychiatric Times article titled "Understanding and Overcoming the Myths of Suicide", Thomas Joiner, Ph.D., Distinguished Professor in the Department of Psychology at Florida State University, includes a section titled "Impulsivity myths" in which he says "Except in works of fiction, I have never encountered a death by suicide that was truly impulsive." Rather than being impulsive, suicide is something people do after long contemplation as part of their efforts to deal with what they consider intolerable life circumstances.
The usual justification for involuntary incarceration and so-called treatment of those considering or attempting suicide is alleged dangerousness to oneself. But even people who don't agree with the principle of self-ownership should ask themselves: dangerousness to oneself in the eyes of whom? To an onlooker, suicide may seem to always be harmful to the person ending his or her life. But that's not how the person committing suicide sees the situation. People commit suicide because they decide continued living in their particular circumstances is a greater harm to themselves than death. This is made abundantly clear by Francis Lear, editor-in-chief of Lear's magazine, in her autobiographical book, The Second Seduction (HarperPerennial 1992, p. 26):
I ALWAYS HAVE an 'exitline.' A stash of lithium. A building tall enough to kill, not maim, for godsake, not maim. One goes out in suicide, one simply goes out, gets out, wriggles, bolts, and does not come back merely smashed up or, as the first priority, left with the ability to feel. One does not go out in a half-assed manner. Suicide has many consequences. It will hurt people who love you, it can splatter the sidewalks; but its purpose, the reason for its magnetism, is that it is the only guaranteed, surefire way to end, blitz, detonate a critical mass of suffering. Suicide, reduced to its pure essence, is a delivery system that moves us from pain to the absence of pain. If the gods contrive against us and the planets are in disarray, if the earth cracks open beneath us, we must always have a way out.
As Dr. Eustace Chesser said, "Suicide is a deliberate refusal to accept the only conditions on which it is possible to go on living" (Why Suicide?, p. 122).
A person's reasons for choosing death may or may not make sense to other people. In a free society, however, that doesn't or at least shouldn't matter. It is a very personal and subjective determination, so how can anyone else reasonably claim to know that a person considering suicide is making the "wrong" decision in terms of "dangerousness to himself" or herself as experienced by that person? As William Glasser, a psychiatrist, says in his book Positive Addiction: "we should keep in mind that we can never feel another person's pain" (Harper & Row 1976, p. 8). In general, I agree with the often heard assertion that "Suicide is a permanent solution to a temporary problem." However, the determination of whether it is best to suffer through a miserable present in the hope of getting to a possibly better future is a value judgment. A person could legitimately decide a hopefully better future does not justify choosing to experience an unbearable present. Emotional pain can be so great refusing to end one's pain by ending one's life can seem like masochism. No one should claim the right to override, by force, a person's value judgments and decisions about something as personal as this.
Another factor to consider is that mental health professionals who force a person considering suicide into "treatment" may be unwittingly promoting suicide, even though they call what they do "suicide prevention". In an article in the May-June 1974 New York University Law Review titled "Involuntary Psychiatric Commitments to Prevent Suicide", New York University sociology professor David F. Greenberg, Ph.D., says studies on psychiatric suicide prevention "have been either inconsistent or negative" and suggest "that institutionalization may not prevent suicide, but, in fact, may result in more suicides" (p. 256, emphasis in original). In his book The Suicidal Mind, psychologist Edwin S. Shneidman says "Neither psychology nor psychiatry can be counted as grand successes as far as suicide is concerned" (Oxford University Press 1996, p. vii). In an interview broadcast April 18, 2009, John Sadler, Professor of Psychiatry and Clinical Sciences and Medical Ethics at the University of Texas Southwestern Medical Center said this:
Well, what troubles me the most about involuntary treatment, other than the obvious humanistic costs, is the lack of any real science to suggest that commitment laws really make a difference in saving people's lives. You might say the sacred symbol of commitment laws is suicide prevention, and we really don't know whether commitment laws really prevent people taking their lives. That seems to me to be very problematic, and that's something that not just psychiatrists need to consider but societies in general, and the lawmakers that make these requirements. [Thomas Szasz: psychiatrists respond, accessed January 16, 2015]
In a study titled "Suicide Prevention: Prevention Effectiveness and Evaluation" supported by a grant from the Centers for Disease Control (CDC), published in 2001 (available at sprc.org), the researchers reached this conclusion: "At this point, most suicide prevention efforts currently in place assume efficacy, with little or no scientific evidence." The researchers warned:
Do no harm is an ethical principle that should be at the forefront of concern when implementing any program. Some suicide prevention techniques are associated with potential hazards. Some hazards may result directly from prevention efforts. ... Without evaluation of programs, we do not know if the program benefits or harms the people we are trying to help. [pp. 16, 20, bold print and italics in original]
A World Health Organization (WHO) study published in July 2004 titled "For which strategies of suicide prevention is there evidence of effectiveness?" reached this conclusion (p. 4):
Findings
About 30 types of suicide preventive interventions were evaluated in the published research, which covered the whole spectrum of primary and secondary prevention efforts. More than half of these interventions fall into the domain of treatment rather than prevention and maintenance. Limited evidence indicates that no single intervention appeared to be effective in reducing the suicide rate.
In Brain-Disabling Treatments in Psychiatry, Second Edition (p. 223) psychiatrist Peter Breggin says—
ECT is frequently justified as treatment of last resort in cases at high risk for suicide. But research uniformly shows that ECT has no beneficial effect on the suicide rate. Indeed, the most thorough study available, published in the British Journal of Psychiatry in 2007, found an overall increased rate of suicide in patients previously given ECT (Munk-Olsen et al., 2007). In addition, "patients treated with ECT in the past week had a greatly increased risk of suicide compared with other patients (RR=4.82, 95% CI 2.22-10.95)" [p. 437, emphasis added].
The study is titled "All cause mortality among recipients of electroconvulsive therapy", British Journal of Psychiatry, Vol. 190, pp. 435-439.
In her book Doctors of Deception—What They Don't Want You to Know About Shock Treatment (Rutgers University Press 2009, pp. 98, 99, 286), Linda Andre says this:
One such study in 1950 found that patients who had received ECT committed suicide at twice the rate of those who hadn't received it. ... Study after study from the 1970s to the present shows that if ECT indeed has any effect on suicide, it is that people who have had ECT may be more likely to die from suicide or other causes than persons who haven't had it ... and that some of those who did made it clear that ECT's effects or fear of further ECT was the reason they had chosen to end their lives.
In his book Suicide Prohibition—The Shame of Medicine, published in 2011, psychiatry professor Thomas Szasz concludes: "There is no evidence that suicide prevention prevents suicide" (p. 69).
At his 2012 Empathic Therapy Conference in Syracuse, New York, psychiatrist Peter Breggin said this:
There are no studies showing that locking up people reduces their suicide rate. That'd be a very easy thing to do. It'd be very easy to look at a hospital cohort, get some sort of an outpatient group, and look at their suicide rates, or at anything else. Not a hard study. If they're being done, they're not being published, because they don't show that there is any benefit to being in a [psychiatric] hospital or being involuntarily confined. [Discussion following presentation by Dr. Rachel Bingham, MBBS]
One reason so-called suicide prevention promotes suicide is the harmfulness of today's biological "treatments" in psychiatry. People subjected to involuntary "medication" often describe the experience as torture (see Why Psychiatry is Evil), and all or nearly all "hospitalized" psychiatric patients, including those thought suicidal, are forced (yes, forced) to take psychiatric drugs. In his book Suicide Prohibition—The Shame of Medicine, psychiatry professor Thomas Szasz warns: "When mental hospitals and psychiatrists use torture, they call it suicide prevention" (p. 98, italics in original). In the same book Dr. Szasz says involuntary treatment of a person considering suicide is "ostensibly to prevent his death, actually to punish him for disturbing the orderly functioning of his family and society" (p. 11).
MAKES SUICIDE MORE LIKELY
The dreariness and cruelty involved in forcing a person to live in a mental hospital may make death seem preferable. As ACLU Capital Punishment Director John Holdridge has observed, "A state hospital is as bad as a prison" (speech at New Hampshire Civil Liberties Union's Annual Meeting, archived at aclu.org). Lawrence Schwartz, staff attorney for the Mental Health Law Project of Washington, D.C., alleges incarceration in "mental institutions is often indistinguishable or even worse than criminal incarceration" ("The Civil Commitment Process: Established and Emerging Rights" in Legal Rights of the Mentally Handicapped, Practicing Law Institute 1973, p. 113 at 128). A woman in Pennsylvania who served time in both the Allegheny County Jail and a psychiatric ward of the University of Pittsburgh Medical Center, both in 2015, told me "I would rather be in jail than be in a mental hospital." In his book Brain-Disabling Treatments in Psychiatry, Second Edition (Springer Publishing Co. 2008, p. 440), psychiatrist Peter Breggin says "Traditional mental hospitals are extremely controlling, authoritarian, humiliating, and physically dangerous places—exactly the opposite of what already overwhelmed people need." In his pseudopatient study, Stanford University psychology professor David Rosenhan found—
Neither anecdotal nor "hard" data can convey the overwhelming sense of powerlessness which invades the individual as he is continually exposed to the depersonalization of the psychiatric hospital. ... The consequences to patients hospitalized in such an environment—the powerlessness, depersonalization, segregation, mortification, and self-labeling—seem undoubtedly counter-therapeutic. ["On Being Insane in Insane Places", Science, January 19, 1973, Vol. 179, p. 250 at 256-257]
Sometimes private, for-profit hospitals are even worse than a state hospital because of prolonged, unjustified, involuntary commitment and expensive, harmful, forced "treatment" such as involuntary electroconvulsive "therapy" (ECT) to enhance profit. According to a Houston Chronicle article—
A [Texas State] Senate committee Wednesday recommended that the state take steps to clamp down on the use of "shock therapy" in private psychiatric hospitals. ... The Senate Interim Committee on Health and Human Services ... has been investigating abuses at private psychiatric hospitals ... Although the use of electroconvulsive therapy, known as ECT or "shock therapy" is tightly controlled in public hospitals, it remains virtually unregulated in private facilities, where its use reportedly is increasing. [Clay Robinson, "Panel suggests tighter rules on shock treatment", Sec. A, p. 17, 04/02/1992]
So-called suicide prevention also promotes rather than prevents suicide because of psychiatric stigma causing lowered self-esteem. In her autobiography, Too Much Anger, Too Many Tears—A Personal Triumph Over Psychiatry, Janet Gotkin calls her hospitalizations after suicide attempts "ten years of indoctrination into my fundamental worthlessness" (p. 383). What would being institutionalized for mental illness do to your self-esteem?
An associated and even more reliable effect of inpatient psychiatric "treatment" is diminished respect from others and anticipated or actual discrimination in education, employment, and important personal, including intimate, relationships.
For these reasons, increased rates of suicide among people considering suicide who get psychiatric "treatment" compared with a similar population of people considering suicide who do not get "treatment" should be expected. The value of recognizing the right to commit suicide is not only respecting individual freedom but preventing the harm and cruelty that typically go on in the name of suicide prevention and, ironically, preventing suicides precipitated in part by counterproductive suicide prevention efforts.
In addition to creating problems that are added to a person's already existing problems, coercive suicide prevention may cause people who are considering suicide to deliberately mislead others about the fact they are considering or planning to commit suicide, making it impossible for others to offer suggestions or ideas or do anything that is genuinely helpful that might make suicide a less appealing choice. As one mental health worker said: "...a person who wants to kill self will do so quietly and will not go to ER [Emergency Room], doctor's office or family members and announce he/she will kill self. It does not make sense to announce it when one knows something will be done to prevent it" (Thimmappayya Hasanadka, a reply to "Can a Suicide Scale Predict the Unpredictable?" by Arline Kaplan, psychiatrictimes.com, May 23, 2011). Psychiatry professor Thomas Szasz was correct when he said "Suicide prohibitions have not succeeded in preventing suicides but have succeeded in preventing people from having an honest, private conversation about life and death. Those persons who trust mental health professionals with their innermost thoughts may quickly find themselves punished with a 'seventy-two-hour hold' or worse" (Suicide Prohibition—The Shame of Medicine, pp. 82-83).
An example is Michael Wechsler, who ended his life at age 26 with an intentional overdose of his psychiatric prescription "medication" the evening of May 15, 1969. According to his father's biographical and autobiographical book, In a Darkness, in which he refers to his son's successive therapists as "Dr. First", "Dr. Second", and so forth, "Dr. Eighth...had seen Michael for a long time during the late afternoon of his final day and detected nothing that inspired any fear. Until Michael's [suicide] note was found, she had convinced herself—and was attempting to persuade me—that his death must have been a pharmaceutical accident." According to Dr. Eighth, her psychotherapy session with Michael only several hours before his death "had been largely devoted to talking about his plans for going back to Harvard [University]" where he had been a student. The next day, after his death, in his bedroom his parents found a large bottle labeled "May 15", where he had apparently stashed the psychiatric "medications" with which he ended his life, as well as his suicide note. Michael Wechsler's true-life story, ending with his well-planned suicide after "therapy" with eight therapists, illustrates a number of truths: (1) Psychiatric and psychological "therapy" is of no or negative value. After Michael's death, his father concluded his son's "therapy, especially in the last months, was essentially worthless or even harmful." (2) So-called suicide prevention actually promotes suicide, in part because of psychiatric stigma. In Michael's father's words: "We had observed during Michael's illness the discomfort he often suffered from being identified as a 'mental patient' and had sensed how being set apart this way had complicated his problems". (3) Mental health "professionals" cannot predict future human behavior, including suicide. (4) Psychiatry's "medications" are toxic (poisonous). In the "therapeutic" range they cause discomfort or disability. In larger doses they cause death. (5) People whose frustrations with life make their lives of more negative than positive value to themselves often know they cannot tell anyone they are considering suicide if they sincerely want to have the option of ending their pain by ending their lives. Reflecting on his son's intentional, lethal overdose, Michael's father wrote: "I remember thinking that, if Michael survived, he again faced hospital 'imprisonment.'" Michael probably knew that, too. He probably also knew he would again face "hospital imprisonment" if he admitted to "suicidal ideation". So he intentionally deceived everyone including his "therapist", Dr. Eighth, with his false plans for the future, giving her and everyone else who knew him not only no chance to subject him to the horrors of psychiatric assault that psychiatrists call "suicide prevention" ("hospital imprisonment", torturous involuntary "medication" and/or electroshock, and 4 or 5 point physical restraints, particularly if the "patient" resists this mistreatment) but also no chance to say or do anything genuinely helpful that might have changed his mind. (James A. Wechsler, In a Darkness, W.W. Norton & Co. 1972, pp. 14, 152, 153, 156, 157).
Protected Freedom of Thought
"Do you have suicidal ideation?" and "Have you been thinking about killing yourself?" frequently are questions in psychiatric evaluations and in civil commitment proceedings. Black's Law Dictionary says "Every confinement of the person is an 'imprisonment' whether it be in a common prison, or in a private house, or in the stocks, or even by forcibly detaining one in the public streets" (1968 edition, p. 890). Involuntary hospitalization is therefore a type of imprisonment. As psychiatry professor Thomas Szasz says in his book The Age of Madness: The History of Involuntary Mental Hospitalization (Anchor Books 1973, p. xi), "mental hospitals, for example—are medical in name only; actually, they are prisons disguised as hospitals." Even if it is called hospitalization, imprisoning a person because of what he is thinking is an obvious violation of the First Amendment to the U.S. Constitution if the First Amendment guarantees and protects the right to think as well as speak and write freely on all subjects. In Wooley v. Maynard, 430 U.S. 705 at 714 (1977), the U.S. Supreme Court said there is "a right of freedom of thought protected by the First Amendment." In Palko v. Connecticut, the U.S. Supreme Court said "freedom of thought...is the matrix, the indispensable condition, of nearly every other form of freedom. With rare aberrations, a pervasive recognition of that truth can be traced in our history, political and legal. So it has come about that the domain of liberty, withdrawn by the Fourteenth Amendment from encroachment by the states, has been enlarged by latter-day judgments to include freedom of the mind" (302 U.S. 319 at 326-327 (1937), overruled on another issue (double jeopardy in criminal cases) in Benton v. Maryland, 395 U.S. 784 (1969). Novelist George Orwell sought to warn against incarceration for what he called thought crime in his novel Nineteen Eighty-Four. His warning about this happening in the future, by the year 1984, was valid whether or not Orwell realized imprisonment called hospitalization merely because of what a person is thinking was a already a reality in 1949 when Orwell published the novel, and regardless of whether the disallowed thinking is called crime or illness. In his book Suicide Prohibition—The Shame of Medicine, psychiatry professor Thomas Szasz correctly points out that "thinking about suicide is simply thinking, a symptom of freedom of thought" (p. 9). Depriving a person of liberty merely because of what he is thinking, with no evidence of biological abnormality needed to establish the existence of an illness or disease, is a violation of the First Amendment right to freedom of thought, whether or not the loss of liberty is disguised as or falsely said to be benevolence or for a supposedly therapeutic purpose.
In his book Death With Dignity, published in 1989, attorney Robert L. Risley says in general "court cases clearly established the right to bodily integrity, confirming that the basic right of self-determination includes the right to die, and that it overrides the state's duty to preserve life" (Hemlock Society, Eugene, Oregon, 1989, p. viii).
The U.S. Supreme Court addressed the question of whether the U.S. Constitution protects the right to die in 1990 in the case of Cruzan v. Missouri, 497 U.S. 261. In the words of Time magazine, in this case the U.S. Supreme Court "declared for the first time that there is indeed a right to die" (July 9, 1990, p. 59). Of the nine justices, all except Justice Scalia acknowledged the right to die is a federal constitutional right. In his concurring opinion, Justice Scalia argued vigorously against the reasoning of the majority and dissenting opinions, both of which acknowledged the right of self-determination is a constitutional right and that it includes the right to die. Justice Scalia opposed the view of the other eight justices, arguing vigorously against what he called the right to commit suicide. But in this respect he stood alone on the Court.
FREEDOM OF THOUGHT IS ESSENTIAL
TO EVERY OTHER FORM OF FREEDOM
_________________________________________________
The Cruzan decision illustrates the fact that courts are more likely up uphold the right to die in cases involving physically ill or disabled people who choose to refuse treatment and allow a natural process to end their lives, particularly if they are conscious enough to express their desire to die or who when healthy enough to do so indicated death is what he or she would want in the circumstances. The sick or disabled person's supposed desire to die is probably in many cases a mere excuse or rationalization that conceals the real reason family members and courts allow them to die. If the sole reason for permitting death was the desire of the ill or disabled person, involuntary commitment of persons who admit they are thinking about committing suicide would not take place. A bona-fide but unacknowledged reason ill or disabled people are allowed to end their lives is they have become a burden to other people. Just as able-bodied people who consider suicide are incarcerated for their own supposed benefit (to supposedly prevent them from committing suicide) when the real reason is selfish concerns of others, people with severe, permanent disability or incurable disease are allowed to die for their own supposed benefit when a real but unacknowledged purpose is to relieve others ("society") of the burden of caring for them.
The U.S. Court of Appeals for the Second Circuit ruled in favor of a right to physician-assisted suicide in Quill v. Vacco, 80 F3rd 716 (1996). The following day a headline in The Wall Street Journal read "Court Rules Suicide is a Constitutional Right" (April 3, 1996, p. B1). The U.S. Supreme Court reversed the Second Circuit, saying there is no "right to hasten death". However, the Supreme Court also said people have "well-established, traditional rights to bodily integrity and freedom from unwanted touching" and therefore may refuse life-saving treatment and deliberately allow a natural process to end their lives (Vacco v. Quill, 521 US 793 at 807, 1997).
Courts split two-to-two on the right to physician-assisted suicide in Compassion in Dying v. State of Washington. A federal district court judge ruled in favor of a right to physician-assisted suicide, only to be reversed by a three-judge panel of the U.S. Court of Appeals for the Ninth Circuit, which was in turn reversed by the Ninth Circuit sitting en banc (eleven judges), which was reversed by the U.S. Supreme Court in Washington v. Glucksberg, 521 US 702 (1997). The opinions of the U.S. Supreme Court in Cruzan, Vacco, and Compassion in Dying/Glucksberg do not support my opinion there is or should be a right to commit suicide, but the rulings in and reasoning of those same decisions create a right to refuse suicide prevention if suicide prevention is considered health care and if the decision to refuse it is made when mentally competent, such as in a psychiatric advance directive.
State courts may find there is a right to commit suicide under state law even if federal courts find there is no such right under the U.S. Constitution. For example, in Baxter v. Montana, a District Court judge found there is a right to physician-assisted suicide under the Montana Constitution, as did a concurring Supreme Court of Montana justice. The Supreme Court of Montana majority ruled in favor of the right to physician-assisted suicide on state statutory rather than state constitution grounds (224 P3d 2011, 354 Mont 254 (2009).
Psychiatrist Allen Frances correctly says "suicide is the most personal of human decisions" (Saving Normal, HarperCollins 2013, p. 14). Other people have no more right to dictate this decision to an individual any more than they have the right to tell a person who to marry or what occupation or profession to enter.
SUICIDE IS THE MOST PERSONAL OF ALL HUMAN DECISIONS _________________________________________________
According to a Jurist news report on May 14, 2013, the European Court of Human Rights (ECHR), interpreting Article 8 of the European Convention on Human Rights, ruled that Article 8—
... protects an individual's right to respect for private life, which was interpreted by the court in the 2011 case Hass v. Switzerland to include an individual's right to decide the way in which and at which point his or her life should end, so long as he was in a position to form his own judgment and act accordingly. In the present case of Gross v. Switzerland, applicant Alda Gross, an elderly Swiss woman, petitioned the ECHR after she could not find a doctor to prescribe her a lethal dosage because she suffered from no clinical illnesses.
The Court ruled in favor of Ms. Gross's right to end her life, saying "that Gross's right to respect for her private life was violated". The report says assisted suicide is permitted in Belgium, the Netherlands, Luxembourg, and Switzerland ("Europe rights court rules Switzerland laws on assisted suicide too vague", jurist.org). A February 2, 2007 news report says "The Swiss Supreme Court has issued a decision saying that chronically depressed and mentally ill people have a 'right' to assisted suicide. ... The suit claimed a right to suicide for the mentally ill under the European Convention of Human Rights." The court said "it is difficult to determine if the desire for death is a function of the illness calling for treatment, or the result of a 'self-determined, carefully considered and lasting decision of a lucid person ('balance suicide') which possibly needs to be respected'" ("Mentally Ill have a Right to Assisted Suicide—Swiss High Court", lifesitenews.com).
Another report, titled "Death on Demand | First Things", dated February 8, 2007, by Wesley J. Smith (http://www.firstthings.com) about the same or a similar decision, says "The Swiss Supreme Court has ruled that people with mental illnesses can be legally assisted in suicide. ... The Swiss high court ruled, 'It must be recognized that an incurable, permanent, serious mental disorder can cause similar suffering as a physical (disorder)'. ... The Dutch Supreme Court [found] that the law cannot distinguish between suffering caused by physical illness and that caused by mental anguish."
According to another report, "A Dutch Supreme Court ruled that a psychiatrist, who assisted the suicide of a woman in grief over her dead children, had not acted wrongly because suffering is suffering and it doesn't matter whether it is physical or emotional" ("Assisted Suicide and Euthanasia—Why the CBC [Center for Bioethics and Culture network] Opposes Assisted Suicide and Euthanasia", http://www.cbc-network.org, accessed July 27, 2013).
I have always had mixed feelings about veterinarians because they kill animals as well as try to heal them. For similar reasons, I am opposed to physicians killing human beings. At the same time, a person's right to decide to end his life and do it by his own hand seems to me beyond question. I oppose the use of psychiatric "diagnosis" to justify force against a person only because he chooses to end his own life.
The above cited European court decisions support my opinion that freedom to choose the time of one's own death, before death becomes inevitable, is a fundamental human right with which other people (acting through government) have no right to interfere. Additionally, the opinions of U.S. courts upholding the right to die, whether with a physician's help or by refusing life-saving treatment, emphasize personal autonomy and self-determination as the reason for the decision and therefore also provide some support for my opinion each person should be considered the sole owner of himself or herself, of his or her own body, and of his or her own life. A logical extension of this reasoning is each person's right to commit suicide provided he does so privately and does not physically jeopardize others, and for any reason that seems sufficient to him, whether or not it seems sufficient to others, and whether or not his decision seems rational to others: It is an individual prerogative. In the words of former congressman and Secretary of Defense Donald Rumsfeld, "free people are free to be wise and to be unwise. That's part of what freedom is" ("Secretary Rumsfeld Interview with Parade Magazine", October 12, 2001, available at http://www.defense.gov). If we are only free to be wise (as judged by others), we are not free but are, in a sense, slaves: To be a slave is to be a person who has no control over his life. Reducing people to this kind of slavery is one aspect of involuntary psychiatric treatment. In the words of psychologist Jeffrey A. Schaler, Ph.D., "Involuntary commitment is a form of assault and battery. ... Normally, we call it slavery when people earn their living by depriving others of their liberty" ("Reply to Allen Frances", August 17, 2012, http://www.cato-unbound.org). The World Book Encyclopedia (1957, p. 7498) says "SLAVERY is a practice in which human beings are held captive, or owned, by other human beings." The essence of ownership is control. Black's Law Dictionary (West Publishing 1968, p. 1559) defines "SLAVERY" as "that civil relation in which one man has absolute power over the life, fortune, and liberty of another." That's the situation of people subjected to involuntary "hospitalization" (and those subjected to involuntary guardianship or conservatorship). Slavery also might be defined as being forced to live one's life for the benefit of other people rather than for one's own benefit. Involuntary mental patients qualify as slaves by this definition because coercive supposed suicide prevention or other psychiatric "therapy" benefits the so-called therapists who earn handsome incomes from their counter-productive suicide prevention efforts and other supposed therapy, not those who are subjected to imprisonment called involuntary hospitalization and assault called involuntary medication, involuntary electroconvulsive "therapy", or forcible and torturous application of physical restraints. As psychiatry professor Thomas Szasz says in his book, Suicide Prohibition—The Shame of Medicine, "Together with mental health, suicide prevention is a cornucopia of pseudotherapeutic 'programs' that deprive people of essential liberties and enrich quacks ... Today, so-called suicide prevention is a quasi-medical specialty and a big business" (Syracuse University Press 2011, pp. 5-6, 11). Another of Dr. Szasz's books about involuntary civil commitment for mental illness is titled Psychiatric Slavery (Free Press 1977, Syracuse University Press 1998).
Considering the cruelty and harmfulness of modern psychiatric treatment, including so-called suicide prevention, and the prevalence of unjustified involuntary psychiatric treatment in supposedly free countries such as the U.S.A., everyone would be well advised to have a psychiatric advance directive refusing treatment for "mental illness", particularly all biological treatment in psychiatry, as well as anything called suicide prevention.
If you are a state or federal legislator who believes in each person's right of self-ownership, you should introduce legislation to delete references to "dangerousness to oneself" in state and federal involuntary psychiatric treatment laws. Judges should strike down as unconstitutional laws that imprison (involuntarily "hospitalize") or permit involuntary outpatient psychiatric treatment only because of a person's past or predicted future harm to himself or herself. Laws allowing imprisonment, preventive detention, or involuntary "hospitalization" for "dangerousness", whether to oneself or others, are unconstitutional because of the impossibility of predicting the future accurately enough to satisfy any burden of proof, as I document in Is Involuntary Commitment for "Mental Illness" or "Dangerousness" a Violation of Substantive Due Process? This being the case, state and federal legislators should repeal laws calling for involuntary hospitalization or outpatient treatment of people based on psychiatrists' (or other persons') predictions of future behavior, i.e., "dangerousness", and judges should strike down such laws as unconstitutional, just as they would repeal or strike down as unconstitutional laws authorizing incarceration or forced treatment based on predictions of future behavior or "dangerousness" by astrologers.
For both ethical and practical reasons, we should respect the freedom of people to do whatever they want with their lives if their past conduct has not unlawfully harmed others.
Thomas Szasz, M.D., Suicide Prohibition—The Shame of Medicine (Syracuse University Press 2011).
Thomas Szasz, M.D., "The Ethics of Suicide" in The Theology of Medicine (Syracuse University Press 1988), pp. 68-85
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The author is a volunteer (pro bono) attorney for the Law Project for Psychiatric Rights (psychrights.org) and may be reached at wayneramsay (at) mail (dot) com