In this chapter, I consider the idea that physician-assisted death might come into question in the cases of psychiatric patients who are incapable of making autonomous choices about ending their lives. I maintain that the main arguments for physician-assisted death found in recent medical ethical literature support physician-assisted death in some of those cases. After assessing several possible criticisms of what I have argued, I conclude that the idea that physicianassisted death can be acceptable in some cases of psychiatric patients (...) who lack autonomy ought to be taken into account in assessing the moral and legal acceptability of physician-assisted death. (shrink)

When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her are obligated (...) to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mental illness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not. (shrink)

In this paper phenomenological descriptions of the experiential structures of suicidality and of self-determined behaviour are given; an understanding of the possible scopes and forms of lived self-determination in suicidal mental life is offered. Two possible limits of lived self-determination are described: suicide is always experienced as minimally self-determined, because it is the last active and effective behaviour, even in blackest despair; suicide can never be experienced as fully self-determined, even if valued as the authentic thing to do, because no (...) retrospective re-evaluation from some future vantage is possible. The phenomenological descriptions of the possible scope of lived self-determination in suicidality, presented in this paper, should prove to be extremely helpful in three different fields of interest: (a) ethical debates regarding the pros and cons of autonomous or heteronomous suicide; (b) clinical day-to-day practice with respect to treating suicidal people; (c) people who suffered a suicidal crisis, attempted suicide or lost loved ones through suicides. (155 words). (shrink)

In the UK and elsewhere suicide presents a major cause of death. In 2008 in the UK the topic of suicide rarely left the news. Controversy surrounding Daniel James and Debbie Purdy ensured that the problem of assisted suicide received frequent media discussion. This was fuelled also by reports of a higher than usual number of suicides by young people in South Wales. Attention attracted by cases such as that of Daniel James and Debbie Purdy can lead to a neglect (...) of the problem of how to respond to the vast majority of suicides, in which there is no obvious accompanying health problem. This paper seeks to redress that balance to some degree. Its focus is primarily on the provision of assisted suicide when the person seeking such assistance has no accompanying health problem. It is argued that a network of suicide centres (SCs) should be established, the purpose which in certain circumstances, will extend to assisting suicide in cases where a competent person has a definite, sustained intention to end their own life. Arguments in support of this proposal are provided, focusing on respect for autonomy, relief of suffering and respect for the ‘life-plan’ of a person. Considerations relating to reduction of harms to third parties are also recruited. Eight responses to the proposal are considered. But none is found compelling, nor are they found jointly compelling. (shrink)

The practice whereby terminally ill patients choose to end their own lives painlessly by ingesting a drug prescribed by a physician has commonly been referred to as physician-assisted suicide. There is, however, a strong trend forming that seeks to deny that this act should properly be termed suicide. The purpose of this paper is to examine and reject the view that the term suicide should be abandoned in reference to what has been called physician-assisted suicide. I argue that there are (...) no good conceptual or philosophical reasons to avoid the suicide label. I contend that intending one’s death is essential to the nature of suicide, and this intention is normally required on the part of the terminally ill patient when she knowingly takes a life-ending drug. Additionally, the analysis shows that any plausible strategy that avoids the term suicide is counteracted by the way in which advocates of the practice want to make it legal. (shrink)

The essay analyzes anorexia as a theatrical performance, complete with its chosen acting school and particular dramatic features (plot, acting style, suspense-establishing mechanisms and motifs).