By Anonymous in Washington, DC
The first time I remember wanting to die was in early childhood. I grew up in a rural area of the Appalachian foothills where I was encouraged to explore and ask questions about nature. One autumn day when I was playing outdoors, I noticed the vastness of the sky and mountains that surrounded me. Suddenly, I felt trapped within the endless patchwork of red, yellow, and orange trees. Instead of exploring, I wanted to escape. My father noticed that I had started to cry, but I didn’t have the words to explain. All I could say was that the trees made me feel sad about living forever. Relieved when he told me that people do not actually live forever, I stopped crying and went back to playing. I think that moment was the beginning of my lifelong death wish.
I have spent the past four decades hoping that my death will come sooner rather than later. Although I have some ideas about where my desire for death comes from, I cannot explain it fully. Maybe it’s just the way my brain is wired. I survived multiple traumas throughout childhood including clergy sexual abuse. I was exposed from an early age to my grandmother’s severe and untreated mood swings, and at age 16 I began to experience the same myself. The family dynamic I grew up with was heavily influenced by unacknowledged generational trauma. Suicidal ideation is common among trauma survivors and people with chronic psychiatric conditions, but (supposedly) it lessens with appropriate treatment.
That hasn’t been the case for me.
I have spent my entire adult life to this point trying various psychotropic drugs, psychotherapies, and alternative treatments including every kind of trauma treatment imaginable; yet my desire to die persists even in the absence of mood and PTSD symptoms.
The controversy over physician-assisted suicide for psychological suffering makes me wish that I could be less private about this aspect of my life; I can count on one hand the number of people who know aside from my therapist and psychiatrist. I hear repeatedly that psychiatric conditions are not terminal illnesses, there is always hope for an improved quality of life, and those who claim to suffer unbearably just need to keep looking for the “right” treatments. Usually, I stay silent instead of pointing out that chronic suicidality is not so simple. The dominant message that “suicide is a permanent solution to a temporary problem” assumes the existence of a problem. What if there is no problem except for a lifetime of suicidality?
I have a successful career in a healthcare profession that I love, and I enjoy my job on most days. My spouse and I have a happy, healthy marriage of 12 years and counting. I stay involved in my community and have meaningful friendships that have lasted for years, some for decades. I have the privilege of excellent mental healthcare, including specialty outpatient providers and a nearby inpatient trauma unit. But despite having so much to live for, abundant treatment resources and moral opposition to physician-assisted suicide, I still give serious thought to moving abroad for the purpose of dying.
I have often wondered how conversations about physician-assisted suicide might be different if the voices of chronically suicidal people were truly heard and respected. Suicide prevention efforts tend to emphasize that pain is temporary, and life improves over time. We hear the perspectives of suicide-attempt survivors who now regret their attempts. We hear from families grieving loved ones lost to suicide, including those who would have intervened to prevent a physician-assisted death if they had been given the opportunity. But the voices of the chronically suicidal are rarely heard, and when they are, they usually speak about passive suicidal ideation rather than an active desire to die without an immediate intention to make that happen. The world does not often hear from people like bioethicist Michael Nair-Collins, whose essay on chronic suicidality is a near perfect match to my own experience. In his words, “I want to die; but not today.”
Living with chronic suicidality does not necessarily mean that one supports physician-assisted suicide for mental health conditions specifically or any condition at all. However, arguments both for and against read differently to a person who has this lived experience. Most articles on this topic leave me questioning whether opponents would regard me as a fully autonomous adult or whether proponents would recognize my life as possessing inherent worth.
Perhaps because I oppose physician-assisted suicide regardless of the underlying cause of suffering, I find paternalistic arguments from the opposition most frustrating, especially when they are written by mental-health providers. For example, the thought of working with a psychiatrist who believes that my suffering will lessen if I just maintain “patience and persistence” in treatment would not be very comforting, even if I do share some of those concerns about the public-health consequences of medically assisted dying. Understandably, providers want to give patients hope and reasons to continue living. But after several years, “Just give it time. Eventually, things will get better,” rings hollow.
A few months ago, I discovered Alexandre Baril’s Undoing Suicidism: A Trans, Queer, Crip Approach to Rethinking (Assisted) Suicide. Baril proposes a “suicide affirmative” approach where all suicidal people have autonomy and access to every support without strings attached — even if the support they seek is for ending their own life. I find this idea alluring. At times, I have wondered if my suicidality might decrease in an alternate universe where I could end my life peacefully in the presence of my loved ones at any time. I’m not alone in thinking that the option to die might make living more bearable; for some people, having a prescription for lethal drugs provides reassurance that enables them to focus on living.
But as a healthcare provider, I have difficulty seeing a place for doctors and other providers within Baril’s suicide affirmative vision. In a society that is truly free, freedom for some cannot mean oppression for others. In every country with some form of legalized physician-assisted death, people with severe health conditions who wish to continue living are at risk for potential manipulation. So are older adults, people with disabilities, and people living in poverty.
Proponents of physician-assisted suicide point to existing safeguards intended to ensure freedom from coercion, but coercion is not always explicit or easy to identify. Healthcare providers evaluating applicants may not always see subtle pressure from family members or the impact of systemic barriers to an improved quality of life. When people like “Denise” and “Sophia” choose to die, full separation of their physical suffering from the burdens of inadequate housing and insufficient income is impossible. Research has shown that financial strain, loss of employment, and loss of housing all have statistically significant relationships with suicidality, so how can suffering be determined “irremediable” in a society that does not prioritize the basic needs of all its members or is strained for resources to meet those needs?
For people with disabilities, ableism is an additional layer compromising freedom of choice for assisted suicide. Research has shown that perception of a disability as severe is associated with more negative views of people living with that disability. As a deaf cochlear implant user, I have seen that people do not limit their pity to severe life-limiting disabilities; I experience being deaf as a positive source of social identity, but people have told me on multiple occasions that they would rather be dead than deaf.
Unfortunately, these biases are widespread in healthcare. A recent study on physicians’ perceptions of people with disabilities reported that 82.4% of the 714 respondents see people with disabilities as having poorer quality of life than the general population. Only 40.7% expressed strong confidence in their ability to provide the same quality of care to disabled and non-disabled patients. Negative perceptions of disability from family members, healthcare providers, and society at large send the message that life with certain disabilities cannot be worth living, which may influence a disabled person’s assessment of their own life’s value. When a disabled person is surrounded by people who think of them as better off dead and their own physician has doubts about how to provide good care, we cannot know with certainty whether their choice for death truly is a free choice.
As much as I want to live in a world that is friendlier to the chronically suicidal, the potential consequences for these other vulnerable groups leave me unable to support physician-assisted suicide. Sitting with these contradictions has become part of my daily life. Conversations about suicide, autonomy, and the value of human life will never be simple. I hope that this reflection adds another layer to that complexity. Uncomfortable as this story may be, there is value in hearing from those who live in quiet company with death and still choose, again and again, to stay.
Anonymous in Washington, D.C. works in a specialized pediatric healthcare field and finds meaning in helping children thrive, especially those living in poverty both locally and around the world. She enjoys creating art and spending time with friends, her spouse, and their cat.
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