When Safety Becomes Slavery : Negative Rights and the Cruelty of Suicide Prevention

Those who would give up essential liberty, to purchase a little temporary safety, deserve neither liberty nor safety.

Benjamin Franklin

Introduction: Individual Rights versus Collective Responsibility

The balance between individual rights and liberties and responsibility to the collective has been a hot topic over the last couple of years, as the COVID-19 pandemic has ravaged the world and, due to the need for public safety measures in order to attempt to arrest the spread of the disease, has ignited intense political friction has ensued between two perpetually warring factions in society. On one side, those who advocate for greater individual liberty (for those who perhaps aren’t clinically vulnerable to COVID and stand a very low risk of death or serious illness). On the opposite side, those who believe that society should prioritise safety over more liberty.

This has been a controversial topic throughout the pandemic, with no clear-cut answer as to where the balance should be drawn between public safety and personal autonomy. It’s not possible to draw a strictly scientific conclusion, because science cannot tell us to what extent we should risk public safety in order to preserve individual autonomy. However, what has been very striking is the outpouring of outrage and indignation over even the most modest of measures geared at protecting the most vulnerable, such as wearing a mask in busy areas; let alone more significant infringements of individual autonomy such as vaccine mandates, or restricting the freedoms of the unvaccinated.

However, there is one topic concerning individual autonomy that has been largely overlooked across society, and one where these tensions between individual rights and personal autonomy do not exist in the same form. Not only that, but those who advocate for their autonomy are written off as being more deranged and unreliable in their judgement than even the most fervent of COVID conspiracy theorists. That topic is suicide.

Denying people the right to die based on "public safety" concerns (e.g. coercion from bad actors) is akin to locking up innocent people in order to protect them from crimes that might be committed against them. #MyLifeMyChoice

— existentialgoof (@existentialgoof) April 17, 2022

Our Right to Bodily Autonomy – Positive Rights versus Negative Rights

In a functioning democracy, individuals have a mixture of two different types of human right. We have positive rights and negative rights.

A positive right takes the form of something that the government is obligated to provide its citizens. This includes the right to an education, the right to unemployment or disability benefits, the right to police protection against crime, and so on.

A negative right is something that nobody is obligated to provide us with, but which nobody may legally deny us without compelling reason. For example, the right to choose where we work and to refuse to undertake forced labour.

In short, positive rights require that certain things be done for me, whilst negative rights require that certain things not be done to me, or at least, which are not to be done to me without my consent, unless there are compelling reasons for overriding this.

The right to die campaign has tended to focus on deliverance from extreme illness as being a positive right that the government should provide us out of mercy, and the majority of those who advocate for, or defend the right to die, stress that only those with terminal illnesses would qualify for any form of assistance. But there has been very little focus on the negative right to be free from violence and free from compulsion. Case law in the European Court of Human Rights (Haas Vs Switzerland), has determined that the right to suicide would be covered under the right to respect for private life (section 8); however, this has done nothing to dampen the monomaniacal zealotry of suicide prevention campaigns aimed at restricting access to effective suicide methods for individuals throughout most of the European states that are signatories to this treaty, including the UK.

We can compare and contrast this to the legal status of abortion. Abortion is passionately defended within the mainstream on the grounds of both negative liberty (the right not to be forced to continue a pregnancy) and positive liberty (the right to abortion as healthcare). This is despite the fact that the bodily autonomy arguments being advanced by pro-choice activists could arguably be confounded by the fact that abortion involves the termination of a second human organism. To be clear, I do not support this argument personally. I make this point purely to demonstrate that abortion is a far less clear-cut case of respecting the negative liberty rights of the individual, due to the fact that anti-abortion advocates will tend to argue that the moral standing of the foetus outweighs the interests of the pregnant woman in retaiing bodily autonomy.

Counter-intuitively, despite the fact that suicide (without qualifications regarding the health status of the individual concerned) is a matter of the bodily autonomy and negative of a single individual, making a choice exclusively with respect to their own body, it has failed to gain any meaningful political traction. “My Body, My Choice” is a catchy slogan. But many proponents of this argument undermine their own slogan when they refuse to defend the right to suicide with equal vigour under the same banner, or in many cases, emphatically reject suicide as a valid and permissible expression of bodily autonomy.

To understand how society has attempted to reconcile this contradiction, we will examine efforts that are being made by the field of psychiatry to discredit suicidal individuals as rational actors and their capacity to both understand what is in their interests, and to make informed decisions based on their true interests.

Individual Agency and the Capacity to Consent

Prior to the introduction of the Suicide Act (1960) in England and Wales, suicide was largely considered to be a moral failing, and suicide condemned as the ultimate act of selfishness. This provided the grounds for making attempting suicide a criminal offence. This is no longer the overriding theme in arguments against suicide. Instead, it has been replaced with far more insidious attempts to call into question the mental capacity of suicidal individuals.

This shift in paradigm makes it much more difficult to establish any support for a legally codified right to suicide. When we describe an individual as “selfish”, we are holding them morally accountable for their behaviour. In order to subject them to moral condemnation, we are required to conceive of them as morally autonomous agents who had the capacity to choose differently, and who therefore may be amenable to social pressure to change their ways and to prioritise the interests of others.

However, if we describe a suicidal person as lacking the capacity to make an informed decision; although this means that they are no longer subject to the moral censure of a ‘selfish’ individual; it also means that they are presumed to lack the capacity to advocate on their own behalf or to understand what is in their own interests. This places suicidal individuals in the almost impossible position of being comprehensively discredited in the eyes of society and the law before they have even had a chance to state their argument. They are effectively reduced to the legal and moral status of children; because like children; they are restricted from being able to make decisions based on what they perceive to be their interests without the need to act covertly in order to avoid legal interventions aimed at frustrating their plans and imposing society’s will on them on the grounds that they are incapable of understanding their own interests and therefore society must act in their best interests, even when this will involve coercive interventions such as involuntary psychiatric holds, or even merely depriving them of access to an effective means of executing their will. It can be argued that this loss of social and legal standing more than outweighs any benefits gained from the absence of de jure legal repercussions of a failed suicide attempt.

In the context of the high social cost that would need to be paid in order to do so (the indignity of being relegated to the status of a child in the eyes of your peers and of the law), it is unsurprising that very few suicidal people will speak out publicly against suicide prevention laws. In my personal interactions with fellow suicidal individuals, I have had the privilege of getting to know a number of high-functioning members of society who also happen to be suicidal and are passionately in favour of the right to die, but who take pains to avoid allowing their real name to be associated with the right to die movement for fear that this may harm their future career prospects, or reduce their social standing in the eyes of others.

Unlike anti-abortion advocates, suicide prevention advocates cannot argue that suicide must be restricted in order to protect an innocent victim. Therefore they instead need to insinuate that the suicidal person is themselves the victim of a decaying society that has become derelict in its duty of care to protecting the ‘vulnerable’. Their argument depends upon denying the agency of the person who commits suicide (similar to a 3-year-old child who drinks bleach from under the kitchen sink without understanding their actions) and transferring responsibility onto society and the government in loco parentis to keep these ‘deluded’ individuals safe from themselves.

If suicidal individuals were considered to be capable of autonomous decision making and accorded the moral and legal status of an adult that corresponds with such a status, then suicide would not be considered to be the pressing public health and safety issue that it currently is. It may still be considered a moral and philosophical emergency; but the grounds for intervening in the negative liberty right to bodily autonomy on the basis of subjective morality would be highly controversial in societies that pride themselves on the importance placed on individual choice and freedom of expression. Similarly, trying to shut down suicide on the grounds that it is philosophically disquieting would meet with intense resistance from those who would perceive it to be an unacceptable infringement of religion into the realm of individual choice. It’s much harder to take away an adult’s right to be selfish, or their right to invest their welfare into a philosophical view of life that diverges from your own, than it is to take away the right of someone presumed to have the mental capacity of a child from acting against their own interests.

In their quest to convert suicide from a moral and philosophical emergency to a health emergency (and therefore legitimise heavy-handed interventions), opponents of suicide have been ably assisted by the field of psychiatry.

The Medicalisation of Psychological Suffering

In bygone ages, humanity looked to religious and tribal leaders in order to divine the ultimate truth of reality from ancient texts and stories passed down through the generations. However, almost a century and a half since Nietzsche first proclaimed that “God is dead”; societies have been drifting further and further away from religion as a source of truth and meaning and have struggled to find anything to replace the vacuum being left behind in our psyches by its absence. As a consequence, we have found ourselves collectively hurtling towards a disquieting state of nihilistic disillusionment in which nobody believes in anything; and nobody can quite figure out what life means and what it’s supposed to be for. A trend which has accelerated since the advent of the world wide web and has put a world of information and different perspectives at our fingertips.

Into this breach left by the priests and witch-doctors have stepped psychiatrists, a clerisy for our technological age. Specifically, the role of psychiatrists is to act as a bulwark to preserve an established and comforting narrative that human societies have constructed in order to affirm the value and meaning of life. This is a narrative that has started to come under threat from the incipient vein of nihilistic thought that has started to creep into the fringes of our collective consciousness. It is in order to quell this growing sense of existential disquiet that we look to the psychiatrists (waving in our faces their medical degrees as a guarantee of the impartial, scientific objectivity of their prognoses and suggested remedies) to assure us that this is, in fact, the symptom of a medical condition that requires medical treatment.

Psychiatry however, does not operate like any other branch of medicine. When you go to your doctor presenting a set of symptoms of a serious illness, your doctor will arrange for a blood test, an x-ray or a brain scan to be done in order to gather evidence of the organic cause of your ailments. If he can’t physically see what’s wrong with your body, then diagnosis will be deferred until the test results come back. After all, it would be pointless to go to the doctor complaining of a sore leg, only to be diagnosed with “sore leg syndrome” and prescribed a course of treatment that is shown to have barely more effective than a placebo in terms of statistical significance, and no more clinically effective than a placebo; and with a range of side effects that can cause permanent damage.

That’s because in order to render a diagnosis of a recognised physical ailment in any branch of medicine other than psychiatry, you usually need to identify the cause of the illness, not merely the symptoms. If your symptoms were something more serious; let’s say that you had symptoms often associated with leukaemia, you would not expect the doctor to put you onto chemotherapy without running any objective tests. But when you visit your psychiatrist or your GP to discuss your psychological suffering, you will likely find yourself being administered a questionnaire which will generate a score. Whether or not you are diagnosed with a mental disorder will be determined by where your score sits in relation to a cut-off point that has been arbitrarily decided based on deviation from a normative standard, and will not take into consideration your life circumstances and personal history in order to determine whether or not your psychological disturbance might in fact be a natural and normal response to life experiences.

If psychological suffering is accepted a natural and normal response to life difficulties rather than a spontaneously occurring brain malfunction, then the process of reasoning which leads them to suicide as a solution now seems more transparent.

Gaslighting Our Loved Ones to Delude Ourselves

Why “Assisted” Suicide is a Misnomer

The current state of debate on the topic of the right to die is centered on the assumption that it will entail the government providing us with a positive right to assistance in dying. However, when you actually look at the detail of what “assisted” suicide actually means in practice; it is simply the case that in instances where a patient is approved for assisted suicide, they are permitted to have access to a lethal substance, which must be self-administered. The other type of right to die is voluntary euthanasia, which does involve someone directly killing an individual. However, this would be more appropriately described as “assisted suicide” as the person requires direct assistance in having the lethal substance administered.

The way that assisted suicide is defined frames this issue in such a way that already favours the status quo and gives the upper hand to pro-life advocates, because it assumes that the default state of affairs would be for the government to spare no expense or effort in order to inhibit an individual from being able to access the means of their deliverance, and that “assistance” simply means that the an individual is allowed to bypass these barriers on a case-by-case basis.

But if I’m trying to walk through a doorway and you’re a big burly man who steps in my way to guard the doorway and prevent me from walking through, then if you were to step aside (after I’ve pleaded the extenuating circumstances pertaining to why you should make an exception and allow me through the doorway), you’re still not “assisting” me in passing through the doorway. In that example, you were falsely and unjustly imprisoning me (assuming I’ve committed no crime worthy of the prison sentence). You’re just allowing an exception to your usual rules that you will tyrannise and oppress those who you have kept captive in your prison without due cause. Thus, we should not allow you to claim that what you’ve done is a great humanitarian act of compassion and mercy until you’ve proven that you had just grounds for detaining me to begin with.

It is also falsely assumed that the government needs to be directly involved in administering any assisted dying program. However, technological advances have ensured that this need not be the case.

Leading right to die activist Dr Philip Nitschke, of right to die organisation Exit International, has invented a device which would enable even the most severely disabled individuals to die peacefully without the need for the direct administration of any lethal substance to the patient. Using Dr Nitschke’s Sarco device, the patient is in control of whether or not the inert gas is released into the chamber, and this can be controlled via eye movements for those who lack the use of their limbs.

We do not need a new positive right in order to access this device. What we need is to restrict the government’s ability to interfere in our negative liberty rights. If the government wishes to ensure that people are not accessing these devices based on a momentary whim, then they can require that the suppliers of these machines implement a 1 year waiting period to ensure that the individual’s choice is stable over an extended period of time. Once the waiting period is complete; the government has no further legal recourse to cause any individual to be denied access, unless they can evidence that the individual has done something in the intervening period which would warrant having their autonomy suspended for a longer period of time.

Neither Individual Safety nor Group Rights Justify Non-Consensual Suicide Prevention

As you can see above, we have taken a look at how safety is often used as a justification for preventing suicide, despite the fact that everything that is unsafe exists within life itself. Now let’s explore why this is insufficient grounds in order to be able to ethically justify what should be considered to be a barbaric practice. Let’s first look at the concerns of disabled groups.

Firstly, if suicide is framed as a negative right (i.e. the government is simply not allowed to exercise coercive measures to prevent you from choosing to die), then they are not making any kind of a positive statement with respect to which lives are worth living, or which lives may not be worth living. Every individual, regardless of their physical capability or capacity to contribute to the economy of their society would have this negative right to be free from interference from the government. No particular group within society would need to have a special (positive) right to die carved out for them by policy on the basis that society does not consider those particular types of life not to be worth living. Framing suicide as a negative right would therefore address this concern.

Some of the most vehement opposition to the right to suicide comes from the world of disability rights advocacy. These lobby groups often find themselves well supported by the right-wing media (ironically those who tend to be militantly opposed to provisions that would improve the quality of life of people with disabilities by increasing state spending in this area) and religious organisations.

Disability ‘rights’ activists object to assisted suicide on the grounds that they fear that it paves a slippery slope towards the obligation to die. However, as a private individual, I have no association with malevolent actors that might wish to make disabled individuals feel unworthy of life, or wish to pressure them into killing themselves. I’m not asking that my needs and my demands be put ahead of the disabled individual’s interest to continue living, because I’m not asking that the government actively makes any special accommodations for my desires which would conflict with the rightful interests of another segment of society. What I’m asking for is not for any specific person or agency to facilitate my death. I’m asking for the impediments that exist at present to be dismantled, so that I may make use of a Sarco device or similar. I would like this not only for the sake of helping me die, but of helping me live; safe in the knowledge that I can’t legally be held captive against my will in case my life circumstances become unbearable.

It is also not reasonable to assume that denying people the right to choose to die will force the government to furnish higher standards of care for the disabled, because they won’t be able to ‘dispose’ of them by offering assisted suicide. If we allow governments the power to confine us to cages with impunity, then we give them less accountability to us, not more. And whilst disability rights groups rightly point out that there are a number of systemic issues that result in disadvantaged groups in society becoming marginalised; it is unconscionable to force those very same individuals to pay the price of society’s failure to provide an equitable society; and to hold them hostage until those problems eventually are fixed, if indeed, that ever occurs.

The very fact that you are oppressing those groups by denying them the right to choose whether they live or die undermines any high-minded claims that you want to ensure that these groups are not disposable. In conspiring to ensure that these individuals remain trapped within the prison of their dysfunctional bodies and/or tormented minds, you affirm the fact that the welfare of these individuals is unimportant in the grand scheme of things, and that they are nothing but chess pieces to be moved around the board.

Whilst I believe that there are grounds for compromise in terms of temporarily restricting access to facilities such as suicide pods that would be willingly provided by another party (for example, imposing a waiting period); if you persist in impeding my access to these willingly-provided services indefinitely, then this crosses the line into a clear violation of my negative liberty right not to be falsely imprisoned and enslaved; as any such law would be designed to ensure that I would be deprived of a dichotomous choice between life and death, and would be more likely to remain alive either due to a failed suicide attempt, or fear of failing a suicide attempt. Because this act of obstruction would become the cause of all of my future suffering, then it could be considered to be passive violence against me and a violation of the Non-Aggression Principle. As such, the continuation of my life (and my suffering) owes nothing to my desire to serve my own interests, and everything to the illegitimate interests of others in using me as a means to their desired ends.

Very much the same can be said with respect to those who claim that we should deny the right to use these booths on the grounds that we must protect “vulnerable” individuals who might ask to use the booths, but whose determination to die is not as immutable as my own, as some would argue that a year’s waiting period is insufficient based on their circumstances, and that they need permanent ‘protection’ to ensure that they can’t choose to opt out of life today and will not be able to opt out 1 year from today, 10 years from today, or even 50 years from today. Those individuals may request that the government suspend their right to decide to die, or they may give a family member or friend the power of attorney in order to prevent them from being able to legally decide to end their life. But this should be a system that people opt in to. Any attempt to take away someone’s right to make their own medical decisions, including suicide, should require robust evidence of incapacity. The current state of psychiatric diagnosis fails to meet this requisite standard of evidence.

Similarly, some would argue against the right to suicide on the basis of alleged “suicide contagion”. That is to say, that one person’s suicide precipitates the suicides of others. If suicide were to be prohibited on these grounds, then that would set a very troubling precedent for all areas of life. That would make you legally responsible for how someone else felt (or may have felt), or what they may do to themselves as a consequence of a choice that you made in your own interests. Therefore, no longer would you be legally allowed to break off a relationship in which the other party was still emotionally dependent on you staying (and there are many suicides that are motivated by rejection in a relationship).

Impeding access to suicide on any of the grounds discussed above based on effects that it could have on others allows the people around us, and the collective as a whole to lay greater claim to ownership of our lives than each of us does as individuals. I did not sign a contract at my birth, agreeing to surrender ownership of my body and suffering to society, or to humanity as a whole. Therefore, unless I have committed a crime that is worthy of surrendering my right to make choices concerning my own life; there are no legitimate ethical grounds upon which society can deem it my duty to remain alive. I’ve signed no social contract guaranteeing the rest of society or the rest of humanity my continued services or existence. I’m not receiving anything in return for having my personal autonomy signed away that I deem to be worthy of the cost of the suffering. None of the arguments that you’ve made as to why death is against my interests make any sense to me, because I do not believe that it is possible for a dead person to regret being dead, or to hanker after the pleasures of life. It is therefore unethical to take measures aimed exclusively at preventing me from bring about my own death.

It’s Not Just About Liberty, It’s About Respect

I do not wish to demonise all of those who support suicide prevention initiatives; as I understand that they tend to be motivated by the fact that they place great value on the lives of those who have been lost to suicide, and those that may yet be saved.

However, as has been discussed in this post and my other submissions on the subject of suicide; any suicide prevention scheme which goes further than voluntarily engaging the suicidal invariably depends on the disenfranchisement of the suicidal.

If you have lost a loved one to suicide and are reading this blog post, then I am sorry for your loss and thank you for taking the time to learn about opposing viewpoints. In some cases, the death of a loved one to suicide will come as a shock when, after exhibiting no discernible signs that they were struggling, the individual takes their own life. It may be in these cases that the individual has not been suicidal over a long period of time, but just happened to be going through difficult times that would have passed were they to have remained alive. If this is the case, then if my proposal of allowing access to effective suicide methods after a 1 year waiting period will ensure that many people going through something similar to this will be incentivised to reach out to support services and choose to wait before making their irrevocable decision, rather than act impulsively and risk severe disability.

However, there are also those who have lost loved ones who were suicidal over a period of years, and still believe that everything possible should have been done to ensure that they didn’t have easy access to effective suicide methods. To these people, I ask: how long would be too long to expect your loved one to have to wait before being granted the right to choose? How long would be long enough to have satisfied you that their decision was made with a settled mind, and based on their authentic interests? After how many failed treatments, in your view, does it become rational to lose hope that things will get better? If your answer is “never”, then I want you to consider that perhaps you are prioritising your own interests in keeping this person around, over their wellbeing.

If suicide was prima facie proof that an individual lacked capacity to make important decisions regarding their own wellbeing, then we might expect that incidence of suicide was restricted to the most low-functioning members of society who, if they were even capable of holding down a job at all, would be mainly found occupying simple and undemanding roles such as bagging groceries at the supermarket.

However, we instead find that the job roles with the highest rates of suicide tend to be some of the most demanding and stressful. These individuals are therefore in the position of being considered mentally competent enough to be expected to be high functioning and tax-paying members of society, and to be integral to the smooth running of our affairs. Yet at the very same time, as per suicide prevention groups, they must also be presumed permanently mentally unfit to make basic decisions pertaining to their own body and wellbeing. These people push themselves to breaking point for the betterment of society; and in return, they are disenfranchised and told that they must effectively live under the conditions of a conservatorship because they lack the agency to be capable of acting in their own interests.

Whilst it is understandable that people want barriers that make it more difficult for their loved ones to make irrevocable decisions in a moment of crisis; such examples do not represent all suicides, and this concern should be adequately addressed by implementing waiting periods prior to accessing such technology as a Sarco suicide booth, as people will be less reticent about engaging with support services and will have more reason to wait before making an irreversible decision.

However, if this is not a compromise that you’re willing to make, and you insist that effective suicide methods should be permanently restricted, because you don’t believe that it is possible for a suicidal person to have the requisite capacity to make that decision even after years or decades of suffering, then your suicidal loved ones have every reason to feel degraded and insulted by the unwarranted implication, and no reason to feel respected.

This, in turn, will intensify their feelings of alienation from others and from society as a whole, which will further reinforce their suicidal feelings. If talking openly about one’s suicidal feelings (as we’re all being encouraged to do by the suicide awareness campaigns that have become ubiquitous these days) is expected to come at the cost of being perceived as too mentally feeble to be capable of exercising autonomy (and nobody ever need prove this assertion), then many will decide that their only option is to continue to bottle up their feelings, and retreat into isolation.

Suicide and the Right to Live Without Fear

The thought of suicide is a great consolation: by means of it one gets through many a dark night.

– Friedrich Nietzsche

The above quote by Nietzsche is one to which I’m sure many readers will be able to relate; not only those who are currently suicidal. The idea that if life becomes too hard, you always have an escape hatch. The knowledge that you cannot be kept trapped in intolerable circumstances can provide great succour even to those enduring the most severe mental distress or physical pain; such as has become evident from those who have been granted the right to die. Amy De Schutter is a Belgian woman who was granted the right to die for chronic and extreme psychological suffering, and found that merely being granted the right to choose for herself, rather than being forced to live by compulsion, has made all the difference to her sense of wellbeing, and claims that the feeling of control that it has given her has “saved [her] life”. When asked about the discomfort that others might experience when confronted with the fact that a physically healthy woman has been sanctioned in ending her own life with safe and reliable suicide methods; her answer is simple “Try to understand it even if it’s against your own belief systems”.

Without the legal right to access a safe and effective suicide method, life becomes a prison sentence. Has anyone else ever thought to themselves “I can’t live this way any more”…only to catch themselves and realise… “I not only can live this way. I have to live this way”. Although it may not be intended as such, suicide prevention policies convey a veiled threat to anyone who is struggling to cope and starting to become unravelled: “if you think that you’re live is bad right now, think of what it would be like living on the streets if you gave up your stressful job. Consider what might become of you if you tried to escape and we stopped you“.

Suicide prevention policies leave us all helpless in the face of an uncertain future. Whether that is economic turbulence that threatens to leave us all worse off, the risk of a future illness or disability that will permanently impair our quality of life, or any other form of life circumstance that might conspire to leave us feeling trapped and searching for a way out, only to find that all of the exit doors are blocked.

Even if you are not currently suicidal; why would you vote to ensure that if you find yourself in intolerable life circumstances, that you will find yourself trapped with no escape? Why would you collude in any such conspiracy against your future self, and why would you conspire against your fellow man and woman who currently have no choice but to live your worst nightmare today?

Next: Share Your Stories and Petition your Government

If you have found what is written above and elsewhere on the blog persuasive, why not consider petitioning your government to roll back existing laws and restrictions which inhibit your ability to access a peaceful and safe death?

UPDATE 17/11/2022 – The UK Parliament Petitions team has rejected the petition on the grounds of being too similar to another petition (for legalisation of euthanasia). I disagree, because my petition is asking for negative liberties to be respected and for Sarco devices (user operated) to be made available. However, I would still recommend signing the active petition here.

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existentialgoof, 7th November, 2022