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Summer 2008 | Vol 11 No 4

The last word

Rational suicide and the older adult

On our own terms

By Ruth von Fuchs

Some things – a meal or a symphony – have a beginning, a middle and an end. Life too can be seen like this.

After an appetizer and an entrée and a dessert we usually feel full, and are disinclined to eat any more. After youth and middle age and elderhood some people feel content, and are disinclined to live any more.

And just as a typical symphony proceeds through a series of movements, introducing and developing a theme and then resolving in a finale, life may proceed through a number of phases and then arrive at a stage where it feels completed.

Not everyone is lucky enough to have a life that fits in with either of these similes. But those who do come to view their life as a finished work may ask why they are not allowed to take their bouquet of roses and leave the stage gracefully.

Part of their difficulty stems from competing life-metaphors that are widespread among their fellow citizens who are not yet old. These younger people often experience life as a river that rushes endlessly onward, a force to which any kind of blockage or stopping is antithetical. A second analogy is also common, especially during tough times when we might consider opting out: Life is felt to be an obligation, a kind of indentured servitude resulting from some implicit contract with the universe.

Together these two images propel us through youth and middle age, the periods during which we might make a few copies of our genes. But once we are past the optimal time for reproduction, new sensations often begin, as Nature starts signalling us that we are off the hook.

One such feeling is the fullness or contentment I have already mentioned. Another results from what economists call “the law of diminishing returns.” My Economics 101 professor illustrated it by reference to the process of eating an ice-cream cone: The first lick is heavenly, the second is delicious, the third is pretty yummy, the fourth is quite pleasant and so on, until lick number 17, which is not very exciting at all.

When people who are having these experiences become clients of professionals who are not yet having such experiences, misunderstanding can result. The ready-to-leave people may be seen as abnormal. Indeed they are abnormal, in the purely statistical sense; not only are they a minority within the population as a whole, they may well be a minority even within the population of senior citizens – many elderly people have had a life so hard and unfulfilling that they never let go of the rushing-river or indentured-servitude metaphors.
But being statistically abnormal may not mean being in need of treatment. It may simply mean being exceptional.

The satisfied people can be exceptional in another way too: Their contentment often enables them to be more realistic. They can be fully aware and accepting of the fact that they and all other animate entities have been “designed” to wear out and go away to make room for the new homes of their genes.

Such people are quite likely to love some of those new homes, as I love my 26-year-old nephew. I am not at all disturbed by the idea of freeing up resources in order to help him have as good a life as I have had. At 67, I am starting to get a few hints from my body, and when the hinting finally turns to shouting I plan to heed it.

But there may be a problem. Currently, self-initiated exiting – by the helium method, for instance – requires not only certain physical abilities but also certain mental abilities, such as the ability to concentrate on a particular sequence of actions. I have always been a rather distractible person, likely because of what is called a low threshold of perception (perceptiveness can be overdone, it seems). Suppose this tendency increases as I age and I get worried that it may compromise my ability to self-deliver, worried enough that I consult a mental health professional in case there is some pharmaceutical remedy.
If I reveal why I am concerned about being able to concentrate, will my suicidal ideation automatically trigger a standard course of treatment for depression?

Or will the therapist’s mind contain some new ideas, such as “rational suicide”? Will he or she protect me from myself only to the extent of helping me avoid doing something that would be seen as a mistake not just by other people but by myself, if I lived to evaluate it? Will there be gentle probing to see if my feeling of completeness has intensified rather suddenly and rather recently, perhaps in the wake of an event such as the death of my husband? Even if it has, will professional concern be leavened with openness and respect, so that I hear something like this:

“You probably know why I have been asking you these questions. And I sense that you too are starting to wonder if it might be wise to wait a while. It so happens that there is something you could do during the waiting time that would embody the prudence we both desire, and that might also help to alleviate your ‘presenting symptom.’ Difficulty with concentration is a common feature of depression, and experience has shown that antidepressant X is particularly effective against this facet of the disease. Would you like to make a trial of this drug? A month or two would likely be enough time to let you see if it made a change for the better, in any way. What do you say?”

Ruth von Fuchs is president and secretary of the Right to Die Society of Canada.

Editorials do not necessarily reflect the views of CAMH.