Is suicide an act of selfishness, cowardice or honor?

Thomas S. Szasz, M.D.

“Suicide is an event that is a part of human nature. However much may have been said and done about it in the past, every person must confront it for himself anew, and every age must come to its own terms with it.”
—Johann Wolfgang von Goethe (1749–1832)

Behind Goethe’s simple statement lies a profound truth: dying voluntarily is a choice intrinsic to human existence. It is our ultimate, fatal freedom. That is not how the right-thinking person today sees voluntary death: he believes that no one in his right mind kills himself, that suicide is a mental health problem. Behind that belief lies a transparent evasion: relying on physicians to prevent suicide as well as to provide suicide—and thus avoid the subject of suicide—is an evasion of personal responsibility fatal to freedom.

Not long ago the right-thinking person believed that masturbation, oral sex, homosexuality, and other “unnatural acts” were medical problems whose solution was delegated to doctors. It took us a surprisingly long time to take these behaviors back from physicians, accept them comfortably, and speak about them calmly. Perhaps the time is ripe to rethink our attitude toward suicide and its relation to the medical profession, accept suicide comfortably, and speak about it calmly. To accomplish this, we must demedicalize and destigmatize voluntary death and accept it as a behavior that has always been and will always be a part of the human condition. Wanting to die or killing oneself is sometimes blameworthy, sometimes praiseworthy, and sometimes neither; it is not a disease; it cannot be a bona fide medical treatment; and it can never justify deprivation of liberty.

Increasing life expectancy, advances in medical technology, and radical changes in the regulation of drug use and the economics of health care have transformed how we die. Formerly, most people died at home. Today, most people die in a hospital. Formerly, patients who could not breathe or whose kidneys or livers or hearts failed to function died. Now, they can be kept alive by machines, transplanted organs, and immunosuppressive drugs. These developments have created choices not only about whether to live or die but also about when and how to die.

Birth and death are unique phenomena. Absent celibacy or infertility, practicing birth control—that is, procreating voluntarily—is a personal decision. Absent accidental or sudden death, practicing death control—that is, dying voluntarily—is also a personal decision. The state and the medical profession no longer interfere with birth control. They ought to stop interfering with death control.

Practicing birth control and practicing death control as well as abstaining from these practices have far-reaching consequences, for both the individual and others. Birth control is important for the young, death control, for the old. The young are often entrapped by abstaining from birth control, the old, by abstaining from death control.

As individuals, we can choose to die actively or passively, practicing death control or dying of disease or old age. As a society, we can choose to let people die on their own terms or force them to die on terms decreed by the dominant ethic. Camus maintained that suicide is the only “truly serious philosophical problem.” It would be more accurate to say that suicide is our foremost moral and political problem, logically anterior to such closely related problems as the right to reject treatment or the right to physician-assisted suicide.

Faced with a particular personal conduct, we can approve, facilitate, and reward it; disapprove, hinder, and penalize it; or accept, tolerate, and ignore it. Over time, social attitudes toward many behaviors have changed. Suicide began as a sin, became a crime, then became a mental illness, and now some people propose transferring it into the category called “treatment,” provided the cure is under the control of doctors.

Is killing oneself a voluntary act or the product of mental illness? Should physicians be permitted to use force to prevent suicide? Should they be authorized to prescribe a lethal dose of a drug for the purpose of suicide? Personal careers, professional identities, multi-billion dollar industries, legal doctrines, judicial procedures, and the life and liberty of every American hangs on how we answer these questions. Answering such questions requires no specialized knowledge of medicine or law. It requires only a willingness to open our eyes and look life—and death—in the eye. Evading that challenge is tantamount to denying that we are just as responsible for how we die as we are for how we live.

The person who kills himself sees suicide as a solution. If the observer views it as problem, he precludes understanding the suicide just as surely as he would preclude understanding a Japanese speaker if he assumed that he is hearing garbled English. For the person who kills himself or plans to kill himself, suicide is, eo ipso, an action. Psychiatrists, however, maintain that suicide is a happening, the result of a disease: as coronary arteriosclerosis causes myocardial infarction, so clinical depression causes suicide. Set against this mind set, the view that, a priori, suicide has nothing to do with illness or medicine, which is my view, risks being dismissed as an act of intellectual know-nothingness, akin to asserting that cancer has nothing to do with illness or medicine.

The evidence that suicide is not a medical matter is all around us. We are proud that suicide is no longer a crime, yet it is plainly not legal; if it were, it would be illegal to use force to prevent suicide and it would be legal to help a person kill himself. Instead, coercive suicide prevention is considered a life-saving treatment and helping a person kill himself is (in most jurisdictions) a felony.

Supporters and opponents of policies concerning troubling social issues—such as slavery, pornography, abortion—have always invoked a sacred authority or creed to justify the policies they favored. Formerly, God, the Bible, the Church; now, the Constitution, Law, Medicine. It is an unpersuasive tactic: too many deplorable social policies have been justified by appeals to Scriptural, Constitutional, and Medical sanctions.

The question of who should control when and how we die is one of the most troubling issues we face today. The debate is in full swing. Once again, the participants invoke the authority of the Bible, the Constitution, and Medicine to cast the decisive ballot in favor of their particular program. It is a spineless gambit: persons who promote particular social policies do so because they believe that their policies are superior to the policies of their adversaries. Accordingly, they ought to defend their position on the grounds of their own moral vision, instead of trying to disarm opponents by appealing to a sanctified authority.

For a long time, suicide was the business of the Church and the priest. Now it is the business of the State and the doctor. Eventually we will make it our own business, regardless of what the Bible or the Constitution or Medicine supposedly tells us about it.

It’s usually none of these things. It’s generally an act of desperation. At times cowardice but it greatly depends on circumstance

Depends on context.

In some civilizations (japanese, for example) it is an honorable thing to take one’s own life in the face of having done something dishonorable – a way of evening the score by taking one’s own life.

In 17th and 18th century France, suicide was also an honorable thing if one had disgraced the family name.

Nowadays, it is less about honor and more about escape.

It is a personal decision.

Your question cannot be answered in such simple terms, it depends entirely on context and circumstance. Read through what @AnonymousAccount8 posted first. It’s very comprehensive, yet barely scratches the surface.

I see it as an expression of pain.

Neither. It’s a choice. Everyone will have their own opinions about what it means.

I agree it is a choice and a personal decision and, personally, I totally support someones right to choose their own death. Obviously I am not talking about some depressed 16 year old whose boyfriend just broke up with her, but…yep, every individual has the right to determine what their personal lines are when it comes to deciding whether or not they wish to continue to exist.
What is selfish and cowardly are the people that insist someone should stay alive, no matter how miserable, sick or unhappy they are to appease their own selfishness and cowardice.

It’s a withdrawal.

Think about playing poker, and folding.

All four, but I think honor suicides may be a thing of the past. Rommel, for example, didn’t want to bring shame to his family after a spectacular military career. It is also a rational decision made by people who don’t want to face the horrors of various terminal diseases and fear being kept alive by the ethics of medicine just to suffer longer.

Hemingway (here he goes again) considered it the ultimate in cowardice, although he eventually became a suicide himself. His father, his brother, sister and niece were also suicides, as was the third of his five wives. His grandfather had attempted suicide and his first wife’s father committed suicide.

When his father committed suicide at the family home in Chicago in 1926 while Hemingway was in Key West, he refused to go to the funeral and told his mother why in a telegram. He called his father, who he loved dearly according to all other indications, a cowardly milquetoast, that she had dominated him into nothingness and it wasn’t a surprise that his last act would be as a coward. A couple of days later a package arrived in Key West from the Chicago address with no accompanying letter It contained the blood stained pistol with which his father had shot himself in the head. Gratis, Mama.

An act of total hopelessness.

Selfishness.

I hear it can be painless…

selfishness, cowardice or honor? Those are all subjective judgements, and they depend entirely on perspective, which may vary with circumstances but certainly vary with the people making the judgement.

Some people who lose others to suicide complain that it was selfish.
Some consider it honorable (e.g. sepukku).
Some who wanted another to face a worse fate or situation claim it was cowardly.

Those are all just subjective judgements. No matter how much someone might or might not agree with any of them, there is no one truth to argue about.

It’s none of those things.

It’s your life. If things are that bad,that you’re happier dead, then it’s your right to do it.

If you want a miserable person to hang around for your own amusement, then YOU’RE the selfish one.

It’s my right to be an alcoholic, or be fat, or vote for Trump….

@AshlynM, why do you classify it as “selfishness”? Do you mean that in a pejorative way (as is usually indicated by the use of that exact word)?

A choice involving great strength of character. Certainly not an act to be judged or criticized. Actually in many cases it should even be admired!

It depends very much on the circumstances and the thoughts that accompany it.

The excellent essay written by @AnonymousAccount8 points out that suicide is a complex issue for both society and the individual contemplating it. At its core, suicide is the desire to escape from a seemingly intolerable state of mind. The reality behind the perception that one’s choice is either to continue to suffer or cease all experience, may be physiological, psychological or a combination of both. Because one cannot know another’s suffering, their judgement is baseless.

However, the person who is suffering may not be capable of making a wholly rational decision. What this person needs to have someone with whom they can discuss their situation that will not promote an opinion as to whether the question of choosing to die is ethically acceptable. This would aid in putting the choice in a broader perspective. Sadly, this option is seldom available.

@Bill1939 the author of the essay is Thomas S. Szasz, a Hungarian-American psychiatrist and psychoanalyst who wrote extensively on the topic of suicide. I probably should have put his name at the bottom of my post rather than the top.

I disagree with the choice always being of either a physical or psychological reason or escaping an intolerable state of mind. It can also be based on the desire to escape an intolerable life situation such as poverty, homelessness, impending old age without the resources to cope. Being a realist is not the same thing as having a defeatist outlook.

If one knows their future is going to be fraught with pain, poverty and demoralizing dependency these are also viable reasons to take control of otherwise uncontrollable circumstances and choose to exit before the bitter end. I know my bottom line, having gone through being completely devastated in the recession and that is homelessness and dependency on others. I would never kill myself over a romantic relationship or many other emotional issues but homelessness, dependency on others and mere existing and surviving vs. truly living and thriving, yep, that’s my line.

None of the above…it is an escape from whatever is making them miserable enough to prefer oblivion to their reality. Nobody can judge that without having lived in that person’s skin. Nobody asked any of us if we wanted to be born so why should we feel we have the right to pass judgement on someone who decided it was unbearable?

Also, gotta love how people see the selfishness in “My life is unbearable so I’m going to check out even though that’ll hurt the people who care about me” but are somehow incapable of seeing the selfishness in “My loved one’s life is unbearable but I’m going to insist that they continue to suffer through it anyway because saying goodbye to them would make me sad.”

My feelings exactly, @Mariah! The attitude that the afflicted person should have “tried harder” as if, up until that point, they weren’t.

I would be interested to know if anyone participating on this thread has ever experienced the sudden death of a loved one or family member by suicide?

@Buttonstc Good one.

@Buttonstc No. The suicides in my family have always been slow and painfully drawn out via alcohol.

I have not but I have a close friend whose father committed suicide. It took her years to make some semblance of peace with it. Most people are too self absorbed to really put the focus on the other persons grief, pain, reasons, they are just blinded by their own pain which is understandable but kind of takes the focus off the core issue, someone elses suffering that was bad enough for them to take such a step. Survivors also feel guilt for not knowing or seeing signs or being able to intervene.

In the case of my friends father her brother had recently died and her fathers wife as well, within about a 4 month time frame. The double losses were too much for him and he ended up shooting himself.

@Buttonstc Two of my uncles killed themselves. I’ve wrestled with killing myself several times in my life. I used to work with suicidal young girls, two of whom eventually killed themselves. Why does that make a difference? My opinion isn’t changed because of it.

It all depends on who is judging.

@LornaLove You are judging.

@Sneki95 I wouldn’t judge, the question implied one should decide at the time. I have no idea why a person commits suicide.

@Coloma, I am not sure how “an intolerable life” is different from physical or psychological reasons for considering suicide as a reasonable choice. Perhaps my use of physical seemed to fail to make a distinction between medical and social (for want of a better term) conditions. I agree that “Being a realist is not the same thing as having a defeatist outlook.” My “bottom line” is that it is the perception of helplessness, being unable to change the circumstances producing suffering leads to considering suicide as an answer.

@Buttonstc, I have personally known of too many successful suicide attempts. My fiancé killed herself by intentionally taking an overdose of prescription medication. My sister hung herself at age 43. I myself have attempted suicide three times, at age seven, thirteen and twenty-one. I was 47 when my sister died and but for the support of close friends would have followed her.

My uncle killed himself. MY neighbor, who.had also been my teacher in middle school killed himself as well.
And a doctor I used to work with also.

@Bill1939 I would agree, it is a combo plate of hopeless/helplessness and running out of options along with it also being a final act of control when all other control over ones circumstance is lost.

Giving some extra thought to this subject and given my own, first time ever, experiences with the idea of checking out the last few years after my descent into financial ruin during the recession…well…I know that not wanting to burden others with your stuff also plays a big factor in contemplating the decision to exit. Discussing the option of suicide is not your daily conversational dinner topic and the topic is so taboo very, very, few people can have a rational and non-emotive discussion about such a taboo subject. I really think if people were more open minded and could untangle their own, heavily ingrained beliefs about suicide maybe more people would not actually follow through because they could freely air their feelings and, perhaps, just in the simple act of being able to have a supportive, understanding, non-judgmental dialogue the person contemplating their demise might find some relief in just being able to air their feelings without worrying they are making others uncomfortable, or,worse yet, that their friends or loved ones are going to sic the mental health police on them.

Because suicide must be contemplated and carried out in total isolation from others this factor creates even more anguish for the party in question and their friends and loved ones. I watched a documentary on a young woman in Belgium where suicide is legal for mental health reasons as well as terminal illness and it was said that just knowing it is an option often results in the person postponing or changing their minds.
I absolutely believe suicide can be a conscious choice for many reasons and short term, situational depression aside, one does not have to be gravely mentally unbalanced to make this choice.

@Coloma I completely agree with what you have written. I doubt that most attempts at suicide result from mental illness.

I don’t see how anyone lives this life without at least pondering suicide once.

Definitely not mental illness in many cases.

^ I wondered that as well.
I think many have thought about it, but never considered actually doing it. I think that everyone thought about suicide for a moment, in one of those times when you get real stressed and sad, and your mind falls into darkness and gets overwhelmed by strange thoughts you’d never actually turn into reality. Like when you get furious with someone and think “damn, I want to kill her” but would never actually do it, you just get caught up in a moment, and when you calm down, you forget what you thought and never consider it again.

^Something like that. Yeah.