The ethics of suicide — assisted or not

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Hippocrates of Kos, Wikipedia)

“A friend of mine decided, for no proper reason, to starve himself to death. I heard of this when he was already in that third day of his fast, and went and asked him what had happened. ‘I’ve decided to take this course,’ he said. Yes, but all the same, what was it that moved you to do so? If your decision is justified, look, here we are at your side and ready to help you on your way; but if your decision is unreasonable, you ought to change it. — ‘We ought to hold to our decisions.’ — What are you up to, man? Not to every decision, but to those that are justified.” (Epictetus, Discourses, II.15.4–7)

This passage from Epictetus encapsulates, I think, pretty much all there is to say about the ethics of suicide, assisted or not. I do not wish to oversimplify an issue that is keeping philosophers, politicians, doctors, and patients involved in endless discussions. An issue, moreover, that carries huge societal and personal implications. And yet there it is. Epictetus is saying three things in this brief excerpt from the Discourses: (i) suicide is admissible; (ii) it is a duty of one’s friends or caretakers to be of assistance to the person who has decided to commit suicide; but (iii) that person has a duty to carry out due diligence, specifically making sure — as far as it is humanly possible — that she has properly considered and evaluated the reasons for taking such an extraordinary step.

“I swear by Apollo Physician, by Asclepius, by Hygieia, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.

To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else.

I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.

Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.

Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I break it and forswear myself, may the opposite befall me.”

(Full text in Greek and English here.)

Notice that the oath begins with a prayer to a select number of Olympian gods, contains a prohibition against abortion, an injunction to share financial resources with one’s teacher, one to teach others for free, and another not to use “the knife,” meaning no surgery allowed. Most modern doctors are in obvious violation of pretty much all these clauses (with the partial exception of abortion, of course).

“Remember that the door is open. Don’t be more cowardly than children, but just as they say, when the game is no longer fun for them, ‘I won’t play any more,’ you too, when things seem that way to you, say, ‘I won’t play any more,’ and leave, but if you remain, don’t complain.” (Discourses I.24.20)

And:

“Has someone made smoke in the house? If it is moderate, I’ll stay. If too much, I exit. For you must always remember and hold fast to this, that the door is open.” (Discourses I.25.18)

The notion here is, as always with Epictetus, simple, clear, and powerful: we are masters of our own decisions and judgments (and of little else). If we decide that things are truly unbearable, then we have a right to exit. But if we stay, we have a duty to do our best with whatever situation is at hand. It is hard to imagine a more frank and liberating attitude about suicide: the decision is up to me, because the responsibility is mine — whether I stay or leave.

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Ethics, general philosophy, and philosophy of science. Complete index, by subject, at https://massimopigliucci.com/essays/

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