The Right to Die

On 24 February 2022, the first day of Russia’s invasion of Ukraine, two Russian warships attacked Snake Island. When the Moskva warship demanded that the crew defending the island surrender or he would bomb them, they responded, “Russian warship, go fuck yourself.” The Russians occupied the island, and two days later the world heard the news that the island’s thirteen defenders had died (in fact, they had been taken prisoner by the Russians, but that was not known until months later). Their defiance became a symbol of Ukrainian resistance.But was the sailors’ choice to defy the warship heroic or just a daring form of attempted suicide?

A suicide is not a beneficial event for the community in which it is committed. It can implicitly call into question the shared values of those who choose to live, raise basic philosophical questions about the meaning of life, undermine the existing order and bring other negative consequences. If one parent commits suicide, the burden falls on the survivor. A strong and healthy person who dies by her own hand impoverishes everyone who benefits from her work.

It is not surprising, therefore, that for millennia most human societies have stigmatised suicide.

The early Christians were an initial exception to this tendency. Many of them committed suicide to free themselves from the curse of sin. Some would even ask passers-by whom they met on the road to deliver the fatal blow, on pain of death. Only Saint Augustine found a justification for condemning suicide by interpreting the fifth commandment—Thou shalt not kill—as including an injunction against killing oneself.

As late as 2020, suicide was illegal in Cyprus, Georgia and several other countries. Today, while no European country punishes suicide, there are still countries in which the penalty for attempting suicide is severe.

Historically, suicides have been denied burial in consecrated ground; their bodies have been dragged, rather than carried, beyond the threshold of the house since carrying them would cause the damned soul to return to torment the living; surviving family members have often been threatened and persecuted. Most suicides have been treated as sinners and cowards. There have been some exceptions, however. Take Jan Palach, who set himself on fire in Prague in 1969, in protest at Warsaw Pact aggression and the Tibetans who did the same in the early part of this millennium in protest at the policies of the Chinese Communist Party. We tend to see such actions as heroic, when undertaken in defence of values that we hold dear. Even the 911 suicide bombers are heroes, martyrs and saints to many in the Islamic world.

Suicide in itself is not seen as morally reprehensible. It can even be romanticised or glorified under certain circumstances. But this raises the question of when continuing a desperate struggle is tantamount to suicide. Is it a form of suicide when soldiers defend lost positions and refuse to surrender when clearly outnumbered and overpowered, choosing instead to fight on until death? The 1943 Warsaw Ghetto Uprising still divides Poles. For some, it was an irresponsible act of self-destruction that resulted in the deaths of 20,000 people, many of them children, while for others it was an unprecedented act of heroic self-sacrifice.

A member of the resistance who falls into the hands of the enemy and, fearing that he may betray his companions under torture, bites on the cyanide capsule, is feted. A mother who has just received a diagnosis of terminal bowel cancer with all its consequences—unbearable pain, bodily humiliation and total dependence on others—decides to end her life, saving herself and her loved ones months of unnecessary suffering and society the considerable costs of palliative care. Many will condemn her, even though her motives—to spare herself and others—are identical to those of the resistance fighter.

Émile Durkheim’s 1951 book on the topic describes two kinds of suicide: egotistic and altruistic. The first type is caused by the suicide’s profound lack of belonging, his sense that he has no community, is not tethered to society. Altruistic suicide is the result of prioritising the needs of the group over those of the individual. But do the needs of the many really justify the sacrifice of an individual life?

In contemporary psychiatry, suicide is treated as the symptom of a mental disorder. In the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5), suicide is conceptualised primarily as a symptom of major depressive disorder, borderline personality disorder and other diagnoses. Self-harm is referred to as “nonsuicidal self-injury disorder.”

While we now attempt to prevent suicide and treat the suicidal, this has not always been the case. In past ages, Christian mystics like Saint Thérèse of the Child Jesus publicly declared their dreams of being skinned alive, submerged in boiling oil, torn apart by wild animals and burnt at the stake, all in the name of religion and many considered them role models.

Even today, the most zealous Christians can be driven into a frenzy of self-mutilation, as in the processions that occur during Lent in the Philippines. These people are not being treated by psychiatrists. Instead, they are respected. The spectacle attracts crowds, as if it were a carnival.

Country, homeland, family, honour, God, religion, party, ideals—these are all treated as justifications for suicide. And we rarely think more deeply about our conflicting attitudes towards suicide because we have created a system of voluntary censorship that protects us from detailed knowledge of what happens: the Recommendations for Reporting on Suicide, developed by leading international health organizations and the media.

We have come a long way from primitive, fear-based taboos around suicide. Our prohibitions have rational justifications. High-profile media reports of suicides can trigger a wave of imitations: a phenomenon known as the Werther effect. Since the 1960s, the global suicide rate has risen by 60% (though it is now falling). It is the tenth most common cause of death and trials suggest that known methods of prevention have low success rates.

More in-depth research, however, has found that the Werther effect is caused by multiple factors, of which the level of media coverage and the fame of the suicide him- or herself are not necessarily the most important. The way in which suicides are reported can significantly reduce their number, as we saw in the case of Kurt Cobain’s widely covered suicide: the detailed reports of the musician’s suffering may have prevented many from following in his footsteps. The opposite of the Werther effect is called the Papageno effect, after a character in Mozart’s opera The Magic Flute, who is dissuaded from committing suicide by a conversation with three young men who suggest an alternative solution to his heartbreak. Discussing suicide in the right way may help to prevent it. While the idealization of suicide can increase its prevalence, analyses of suicidal thoughts that were not followed by suicidal behaviours can decrease it. Media reports showing people in crisis who adopted coping strategies other than suicide have had a beneficial impact. The Papageno effect is not mentioned in the media guidance for reporting on suicide.

Every person has an inalienable right to death, even though most modern societies deny people the freedom to choose to end their own lives. We tend to see death as an unambiguous evil and consequently impose an obligation to live on others. But life ceases to be a privilege when someone is suffering unimaginable pain, as in the case of many of the terminally ill. In such circumstances, death is the lesser evil. We have no problem making such a judgment in the case of a sick animal. But when it comes to human beings, we generally only grant them the right to die in the ways that we find acceptable.