Faye Girsh is the Founder and the Past President of the Hemlock Society of San Diego. She was the President of the National Hemlock Society (Defunct) and the World Federation of RTD Societies (Extant). Currently, she is on the Advisory Board of the Final Exit Network and the Euthanasia Research and Guidance Organization. Here we talk about culture keeping the ship anchored at the dock.
Scott Douglas Jacobsen: Even with the availability of the means by which to kill oneself in desperation or to commit an act of rational suicide, the taboos in the culture can prevent this, extending possible human suffering beyond reasonable timings.
One, what are those cultural barriers?
Faye Girsh: We talked earlier about religion and the value of Life itself, quality notwithstanding. Suicide is a taboo in both religious and secular circles. Religion sees it as an act against God who gives life and takes it away. In society generally it connotes some kind of mental illness or irrational, even selfish behavior. It is inexplicable that, if life is the supreme value (as we see in the education many doctors get) then not preserving it as long as possible is stupid or evil, but certainly not laudatory. In Ernest Hemingway’s recent biography John McCain is seen as saying that Hemingway’s suicide is understandable because of his inability to do what mattered to him. That is a pretty enlightened perspective. One wonders if McCain contemplated suicide as his brain tumor was progressing, much like Brittany Maynard did. People would argue that aid in dying, because of a terminal or incurable illness, is not suicide since the person would, absent their illness, want to live. A suicidal person wants to die, though I think this is simplistic. You raise the issue that these cultural taboos and stigma may serve to prolong suffering. The reason we have some of these restrictions on suicide is that, for some people, their suffering does ease (e.g., from the death of a loved one or being bullied by peers) and life continues. For others, whether from a chronic psychiatric condition or a medical one from which there is no recovery, indeed the suffering continues and worsens. Not providing an honorable and peaceful way out is cruelty.
Jacobsen: Two, why are those cultural barriers intimately tied to the legal structure, or lack thereof, around issues of rational suicide?
Girsh: Good question! In most civilized countries, ours included, suicide is not unlawful and is considered a medical condition that should be treated. Thus, when someone is talking about ending their lives, or makes an attempt, they are encouraged to voluntarily commit themselves for psychiatric treatment or they are committed involuntarily on a temporary hold. The assumption, realistically, is that the urge to die is a result of a treatable situation. Lives have been saved because of this enlightened position. But, assisting a suicide IS a crime which can carry a long sentence — even when the deceased person has requested — nay, begged — for the remedy. Such was the case when Dr. Kevorkian was found Guilty of Manslaughter and sentenced to 10 to 25 years in prison. Millions of people watched Tom Youk, in the final throes of ALS, begging to die and Dr. Kevorkian asking if he was sure or wanted to wait. The legal doctrine is something like, consent to be killed does not exonerate the person who “kills.” It is also not legal to tell someone how to end her life despite her pleading. This interference by the legal system has prevented doctors from doing what they — and their patients — think is appropriate and merciful. Even an act like administering morphine before removing a breathing tube to let a person die is feared by many to be a prosecutable act. The prospect of a legal complaint or judgment when working with a sick patient who dies is enough to fail to treat that patient with enough pain relief. Even civil cases are brought against nursing homes when a 98-year-old patient die. Much suffering is caused by overly broad reaches of the law where death is concerned.
Jacobsen: Three, how do culture and law relate to one another in a feedback process in change in culture leading to change in law, alteration in law bringing alteration in culture, and so on?
Girsh: As in the example above, suicide used to be thought of as a crime, albeit one hard to punish. It was done by penalizing the family, taking money from the estate, and not allowing the person to be buried in a regular cemetery, or even driving a stake through the body. These were the punishments wrought by the Church and embodied in civil law. As religious explanations were supplanted by medical theories mental illness became the explanatory concepts and the punitive measures became medical ones. Similarly it was religious concepts that dictated that pain during childbirth and at the end of life were redemptive, modern theories of anesthesia took over and suffering was relieved instead of endured. But that idea still exists around dying. There isthe religious stigma that suicide is against God’s will. It is the reason given for the millions of dollars poured into anti-assisted dying campaigns around the country. As religion plays a diminishing role in Americans’ lives, people see that the choice of how life can end may be an acceptable cultural option.
Jacobsen: Thank you for the opportunity and your time, Faye.
Girsh: Thank you, Scott.
Scott Douglas Jacobsen is the Founder of In-Sight: Independent Interview-Based Journal and In-Sight Publishing. He authored/co-authored some e-books, free or low-cost. If you want to contact Scott: Scott.D.Jacobsen@Gmail.com.
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