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Okay, not a train. That's an asshole thing to do. If you're going to commit suicide, don't involve other people.
I included it because it's the stereotypical thing to do (at least around here), but thinking a bit further, it's probably that way because when someone does it, everyone in the train knows. Probably most people have been on a train that's been delayed because of a train suicide. Other methods of suicide don't get that attention.
I do absolutely think we shouldn't be offering assisted suicide to people who are physically capable of unassisted suicide.
This is surprisingly hard to do. Someone needs to find the body and unless you plan carefully this can easily be a random bystander or group of random bystanders (and planning carefully is hard when you are suicidal).
Usually EMS and healthcare get involved and seeing someone who has committed suicide can be deeply harmful (especially if it's gruesome like a gunshot to the head). Often they'll have to run a code on the body even if it's clearly dead which is....awful.
Then you have to think about the family and friends of the deceased. Having a close contact or family commit suicide is a risk factor for suicide it hurts people around you in a way that just dying doesn't.
Yes, suicide is bad. Ideally there would be no suicide at all. This is part of my point.
When we do something in an official manner, we thereby give it a stamp of approval. We should not approve bad things if we can avoid it. Because by doing so, we are saying that the bad thing shouldn't be considered as all that bad. We are shifting the norms and encouraging more of it. We can't always avoid this, but we should at least always try.
If someone's dying anyway, say with terminal cancer, and we artificially keep him alive at that point (which we've gotten quite good at), we are merely prolonging his suffering. At that point, sure, just end it humanely.
But this person (and see my other comment, there are more) was not actually dying. She was in fact physically healthy. There is no argument to be made that we are prolonging her suffering. We are not actively doing anything. There is no argument to be made about freedom either. If you are physically capable of killing yourself, you always have this option.
She could've ended her own life herself at any time. And that would still be bad, even if it truly is the least bad option it's still bad, but we would at least have avoided giving the act an official stamp of approval. And maybe she never would've killed herself, and then there would've been one less suicide. This is the point that I was trying to make.
And it does seem to be accelerating. I looked up the statistics (see my other comment for the sources). There were 14 euthanizations for purely psychiatric reasons in 2014. By 2024, this had grown to 219. In the same year, there were 1819 traditional suicides. So by now, for every ten suicides we're adding an eleventh.
Sorry I don't really have a dog in this fight I just wanted to make that point specifically.
In truth I remain somewhat undetermined about how to handle this specific issue which is awkward given the possibility of it appearing in my clinical practice, however my plan is to just follow legal, regulatory, and hospital frameworks and stay out of the ethical side of this thing.
That said it is worth dialing in just how miserable certain classes of patients are. Again I'm not convinced we should assist them in dying but certain patients have a lived experience that is comparable or worse than the more typical examples (dying of chronic disease, intractably bad life experiences, significant chronic pain*).
For instance someone with severe borderline personality disorder may find themselves zigzagging from being too happy to wanting to kill themselves to burning down their relationships to getting fired to whatever on a regular basis. With associated involuntary suicidal ideation it can approach a point where the life experience is almost abhuman, miserable, and devoid of the traditional pleasures of existence.
That's a reasonably good case, especially since some people like this may struggle to successfully kill themselves because the system does a good job of preventing it and because the problem isn't pure depressive misery, therefore it becomes challenging to overcome the routine desire to live.
Again not necessarily advocating here just pointing out if you had chance to interact with one of these people you might go....oh yeah, I get it, holy shit (or might not).
*Although best we can tell this is somewhat linked to psychic distress.
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