Monday, July 12, 2010

Despair and the Pursuit of Happiness

Guest blogger Sara Prince weighs in again.

Last week, many of you heard the saddening piece on the BBC news (weekdays 9-10am on WMRA) about new physician-assisted suicide regulations in Switzerland. This came after allegations that the founder of Dignitas, one of the country’s most popular assisted-suicide organizations for foreigners, has become a millionaire since founding the company in 1998. While physician-assisted suicide organizations potentially profiting from the taking of human lives is up for debate, discussion, and potential legislation, there is another factor at play – should such organizations even exist?

Suicide organizations in the United States are unlikely as the practice is illegal in every state except for Oregon, which does allow terminally ill patients to receive professional assistance with ending their life. But concerns for a person’s welfare and state of mind are rampant.

In an article from the Annals of Internal Medicine, The Debate Over Physician-Assisted Suicide: Empirical Data and Convergent Views, one viewpoint suggests that “patients who request that death be hastened” should have their request “viewed as a ‘cry for help,’ the meaning of which should be carefully explored.”

But the state of a person’s mind is difficult to interpret – particularly where clinical depression is concerned. According to the above article, depression can distort a patient’s judgment regarding treatment options and potentially life-ending decisions. However, this viewpoint remains an issue as there are no set standards and limited supporting research.

So the question becomes: What if a person’s request is found to be sincere and longstanding? And what if terminal illness is inconsequent to the debate?

After reading the Pulitzer Prize winning book, Middlesex, by Jeffery Eugenides, I began to think a lot about one of the main characters who was introduced by the following description:

“In the summer of 1922, my grandmother Desdemona Stephanides wasn’t predicting births but deaths, specifically her own. She was in her silkworm cocoonery, high on the slope of Mount Olympus in Asia Minor, when her heart, without warning, missed a beat….Squinting in the dim light, my grandmother looked down to see the front of her tunic visibly fluttering; and in that instant, as she recognized the insurrection inside her, Desdemona became what she’d remain for the rest of her life: a sick person imprisoned in a healthy body.”

The author of this fictional tale goes on to explain the many tragedies suffered by this character, Desdemona – the murder of her parents, the burning of her homeland, life in a new and confusing country, and the death of her son, among many other tragedies.

Her response was a gradual letting go of life.

Eugenides, in his novel, suggests that the pursuit of happiness is an American phenomenon. He writes: “The lesson of Desdemona’s suffering and rejection of life insisted that old age would not continue the manifold pleasures of youth but would instead be a long trial that slowly robbed life of even its smallest, simplest joys. Everyone struggles against despair, but it always wins in the end. It has to. It’s the thing that lets us say goodbye.”

It’s a philosophy that I’d never personally considered. If life has to have an element of despair, is physician-assisted suicide such a terrible thing when that person is unable to experience, as Eugenides writes, “even the smallest, simplest joys?” And, if life was devoid of despair, would death, when it inevitably arrived, be far harder to handle?

What do you think?


  1. People are living longer.

    This generation is expected a long a fruitful life filled with medical interventions that keep their hearts ticking and bodies moving.

    Generations of the past may have dreamed about living longer lives, but probably did not have the foresight to plan how they would carry out their extra time on this earth.

    I think physician-assisted suicide–a horrible name, by the way–is a viable approach to helping people end their life with peace of mind. My only condition to accepting this practice is that the dying person's family is involved and agrees to any procedures.

    Life's too long :) Who can argue with someone if he thinks his time on this earth has passed?

  2. What if a person's expressed wish is sincere and longstanding and if terminal illness is inconsequent to the debate?

    When it comes to entrepreneurs like Minelli and Geiger facilitating death for young and healthy, or mentally ill, people, I get a little creeped out. A depressed youth from a wealthy family, or an affluent mom with post partum depression, can go to Dignitas and be euthanized within 24 hours, no questions asked. This despite the fact that these doctors/lawyers don't need to have medical expertise in the area of mental illness, or even medical expertise in whatever area may be pertinent to the suicide's case. And the fact that these people are potentially, although not necessarily, profiting from the poor decision-making of a hapless individual, and potentially, although not necessarily, causing untold suffering and hardship in the families of the suicide, is distasteful to me. There is too much power in THEIR hands, and not enough in the hands of the person who wants to die. Because isn't it true that young and mentally ill people can take their own lives more easily than old, terminally ill, or bedridden patients? If young and healthy people want to die for reasons that are not readily apparent to any life-embracing human being, should they not have to inflict their own death? Why should that be any person's responsibility (let alone a physician's), unless such person can confidently announce -- even prove -- to the world with some degree of recognized competence that the suicide's life is not worth living? "Worth living" is, of course, the mysterious and unknowable question in so many end-of-life cases, but I think some enforced criteria for readiness to die is not a bad thing; otherwise, how can it really be distinguished from murder? Dignitas maintains that, as a private organization, it is not answerable to the public for its finances or -- apparently -- its procedures in honoring the wishes of suicides. This seems wrong to me. In some ways, Dignitas seems like a business that can (even if it doesn't intend to) exploit the exercise of the right to die.