Sector News Suicide — 03 April 2014

It might be in the fine print but one of the first things the Australian  Bureau of Statistics warns upon the release of the latest suicide statistics is  that ”care must be taken” in their interpretation.

While some journalists heed the warning, there will always be those who do  not. After all, the rate at which we kill ourselves cannot but make a  sensational news story.

Yet the moral panic that ensues each time newly minted suicide rates are  published is far from helpful. Yes, of course there are deaths about which the  community should be concerned. These groups include those who are young and  those who are mentally ill – the latter of which includes anyone who is so  depressed that they have no capacity to decide on anything, let alone whether  they should live or die.

However, one question that remains unaddressed whenever the statistics are  published is whether there are other deaths hidden in the mortality dataset  that, dare I say, should be looked at a bit harder – suicides that are anything  but irrational acts, suicides that were carried out sensibly, with forethought  and planning, and, quite often, with the full support of the person’s family and  loved ones.

The question is, should society be alarmed and dismayed by this? Last year  Exit (my organisation) was contacted by the Victorian Coroner’s office seeking a  new expression for the increasing number of rational suicides that it was  dealing with – that is, voluntary euthanasia Elderly Hand On Handsuicides.

For too long medicine has conveniently sought to ground suicide in a range of  psychiatric indicators. If a person kills themself, the medical literature has  authoritatively argued that they were not, by definition, acting rationally.  Delusional perhaps. Depressed definitely.

In this respect studies rarely acknowledge the idea that suicide can be a  rational, reasonable response to an intolerable life.

Working in the field of voluntary euthanasia, this trend has long been  obvious. Getting my medical colleagues to entertain the apparently dangerous  idea that suicide can be a rational act has become an important part of my  professional work. However, try as I might, the medical establishment has long  held the line that only a very, very small proportion of suicides – maybe 1  or 2 per cent – are free of mental illness. That is, until now.

Last month the Canadian Journal of Psychiatry changed this. A chink  was made in the armour that frames depression and the suicide prevention  debate.

In an article titled ”Suicide: Rationality and Responsibility for Life”,  Canadian academic psychiatrist Angela Ho has struck out. Yes, two-thirds of  suicides may be driven by an unsound mind but a significant minority are not.  Rather, these suicides are rational.

Following on, these suicides are not ”bad” and barriers should not be  placed in front of those who pursue this course of action.

As someone who deals daily with people who are so seriously ill or so old and  frail that the option of a peaceful death is a very real consideration, I  welcome the Canadian ‘‘breakthrough’’.

Surely this would allow me to speak more openly about the hidden face of  suicide, without those in the suicide prevention and pro-life industries howling  me down. How naive I was.

In February, shortly before the Canadian article appeared, I was invited to  give a breakfast address to the staff of the Sir Charles Gairdner Hospital in  Perth. On the morning in question, the room was full of medicos, many from other  hospitals coming along to listen and participate in the discussion.

As with most talks of this nature, the assumption was that Chatham House  rules would apply – we would not report on the proceedings. We would all  participate in friendly, collegial, intellectual debate for its own sake.  Audience and speaker alike should feel free to engage and think out loud.

As talks go, the session was lively, the coffee and croissants popular.  Little did I imagine that two weeks later my ideas about rational suicide in the  context of old age, frailty and serious illness would form the basis of a  complaint by the head of pain management of the CGH against me to the Medical  Board of Australia. Again my medical registration is in peril.

My apparent transgression was that I dared to suggest that suicide is not  always and necessarily the act of a person who does not know what they are doing  or why they are doing it.

More than this. I retold the story of Valerie Purcell. Valerie was the last  of my four patients who used the Northern Territory’s Rights of the Terminally  Ill Act back in 1996.

Valerie had been the poster girl of successful, modern palliative care. While  her cancer was still lethal, in its final stages she had few symptoms. Valerie’s  major complaint was that sitting at home waiting for family to visit, waiting to  die, was not living. Nor was not being able to play golf.

That was why Valerie came to Darwin from Sydney to use the Rights of the  Terminally Ill (ROTI) law. Valerie chose suicide, rationally. To dismiss her as  someone ”who wanted to die because she couldn’t play golf” is to seriously  miss the point. To seek my medical deregistration because I was apparently  ”normalising suicide” by discussing the details of her death with medical  colleagues, more so.

Of course in 2014, the over-80s are killing themselves at a higher rate than  any other age group. These self-directed octogenarians are voting with their  feet. They are exercising their minds and free will to control their passing;  rather than waiting for some institutionalised ”natural” alternative. Surely  these are the suicide statistics our society should be proud of?

This article first appeared on ‘Sydney Morning Herald’ on 1 April 2014.


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