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Essay

Opting out

FOR MANY AUSTRALIANS, suicide is still a secret, shameful business. Like incest and child abuse, it doesn't happen to us. The secrecy lies, I think, in its universal and seductive power. It can tempt anyone at any time, as the logical answer to unbearable difficulty. For most of us, the pull of life outweighs it in an instant or an hour, but for a few of us the call becomes imperative. Those few, driven to commit the final, irrevocable act, those few who could have been you or me, are difficult to talk about. Outside the language of reports and statistics, suicide remains lace-curtain hush-hush territory.

But all that is set to change as our population ages and as the Baby Boomers begin to contemplate the extraordinary fact that they too will die. Having fought for greater choice than their parents had in the way they live, they are starting to fight for greater choice in the way they will die. Suicide is starting to come out of the closet.

There has been a tendency to assume that merely living in this country is enough to inoculate us against suicide. Life here is good: we just have to grasp it with both hands. Suicide is more understandable in a country like Hungary, for instance, where a notorious national melancholy combined with years of oppressive Soviet rule. Understandable, too, in a country like the former East Germany, when neighbours spied on each other regularly and the moral universe slipped bizarrely askew. But not here, not in our "lucky" country.

And yet, and yet ... we have a higher suicide rate than the United States and the United Kingdom; we come thirty-fifth out of a hundred countries. More recently, our farmers – defeated and driven desperate by drought – have been killing themselves at the rate of one a day. In the 1990s, youth suicide was reaching frightening proportions. And now it's the elderly who have started taking centre stage.

When youth suicide was the hot topic, it was relatively easy to discuss; most journalists and commentators were talking of an alien generation with whom they had ceased to identify long ago. Farmers are a tragic statistic too, but it's happening "out there" in our vast, sparsely populated hinterland, not to the majority clinging to the coast. The more dangerous, fraught – and increasingly topical – subject is suicide for the ageing and the aged. When the discussion begins to teeter around our own generation or the generation preceding it – our own parents – the fault lines open up. Not only are we starting to think about something as intensely personal as our own mortality, we're also entering an area mined with legal and moral shibboleths. Suicide. Assisted suicide. Euthanasia.

 

THE "RIGHT TO die" question is thrown into unbearable focus once you've witnessed the suffering of someone you love nearing the end of their life. My own mother was in her eighties, in good spirits and relatively robust health when my father died unexpectedly. The physical and mental malaise that hit her after his death was a tornado from hell. No one, least of all she, could have anticipated it. In a very short time, she became consumed by the wish to die. After several unsuccessful attempts at suicide by gentler means, she threw herself under a train.

What happened to my mother fits no neat category. She had never been a depressive, so a diagnosis of "clinical depression" was not (for me at least) convincing. And, while she became ill and suffered intensely, there was no clear and definite physical diagnosis, far less a terminal illness. Even if our laws had allowed for euthanasia (as they do in Holland, Switzerland, Belgium, parts of South America, and in the state of Oregon), she would not have been eligible under the stringent euthanasia criteria. Frail, ill and deeply unhappy, she had to die by her own efforts.

In the months before her final successful attempt, I argued constantly with her that she should stay alive, that there was hope for a good last few years. I and other members of our family took every preventive measure we could think of to keep her alive and get her better. Yet, despite that, I never questioned her right to make her own decision and to end her life as she chose.

But the thing is, she did not have any decent choices. Taking your own life, especially if you are old and ill, forces you into dark and terrible back alleys of secrecy and unwished-for violence.

Suicide for the elderly is not easy to achieve, and it's become harder. It's not a matter, as it might have been some years ago, of taking enough barbiturates and lying down in your own bed hoping never to wake up again. That's how we'd all prefer to do it – perhaps with someone we love dearly at our side. But that's out of the question, on two counts: barbiturates are no longer legally available (you have to travel elsewhere and smuggle them in) and your loved helper or witness is put at risk of prosecution. Other legally available options like quantities of sleeping pills or anti-depressants are often ineffective. Phillip Nitschke may have a suggestion or two towards a civilised means of death, but our government has chosen to make it illegal for him to convey his thoughts on the phone or online to the thousands who look to him for help. There is a $100,000 fine for online communications and Nitschke's book, The Peaceful Pill, is banned.

According to Marshal Perron, who pushed through the short-lived euthanasia legislation in the Northern Territory, three old people over seventy-five kill themselves each week, and most of them are forced into unpleasant and lonely options – hanging, drowning, throwing themselves in front of a car or train or out a window. Only the truly determined will take on the planning and subterfuge needed. My mother was such a woman.

 

AFTER MY MOTHER killed herself, I was so submerged in our own horror that it took me a long time to open my eyes and ears to the world around me. Once I did, I heard many stories: "my cousin, my friend, my uncle, I myself ..." Everywhere I looked, I found suicide – in my own family, in my partner's family, in a close friend's. The town nearest to where I live is known as the suicide capital of New South Wales. My literary landscape is littered with suicides – Plath, Woolf, Hemingway, and more recently Primo Levi, possibly another victim of long-term Holocaust trauma. (It is thought that Levi's fall down the staircase of his Rome apartment building was no accident. It may be, then, that some things cannot be "written out" of oneself, no matter how rigorous and emotionally searing are the books one writes.)

Once suicide happens in your own family, statistics take on a disconcerting fascination. You look to them for fellowship and comfort. It happens to other people; your family is not somehow cursed. I now know that there are over two thousand suicides a year in Australia, and that's just the officially reported cases. For every suicide, there are some thirty attempts. Men between the ages of twenty and thirty-four account for 22 per cent of all deaths. The official statistics for older people are low, but of course they don't take into account all the times when the cause of death is discreetly lied about, or where the morphine is quietly upped on request. The Voluntary Euthanasia Society's figures are much higher – it estimates that at least 3,000 people over sixty-five commit suicide each year, and that figure is probably a gross under-estimation.

Old people don't always wish to die because of terminal illness or physical infirmity. Often it's the emotional pain of living. In one Dutch study, fully 62 per cent of those wanting to die and wanting the state's assistance in doing so cited psychic pain as their primary reason. And is not mental pain as good (or as bad) a reason to want to die as physical pain? Mostly both kinds can be ameliorated by drugs, or various strategies, or simply by the passage of time. But sometimes amelioration is impossible or inappropriate.

In the twentieth century and into the twenty-first, we have medicalised suicide, rendered it a psychological problem that can be "solved" with drugs and/or counselling. We have developed impersonal vocabularies: "suicide prevention programs", "suicide statistics", and so on. We are convinced that suicide is in all cases avoidable. We don't see it as a legitimate choice. We give short shrift to Camus' famous dictum that there is only one fundamental philosophical problem and that is to decide whether life is worth living.

Anti-depressants, early intervention programs, specialised counselling have all become the prophylactics against terminal despair.

It wasn't always so. In other times and other places, suicide had a relatively good press. A mere spit of time ago, in the nineteenth century, the suicide was lauded as the epitome of youthful courage and rebellion. The Romantic poets praised a young man (it was usually a man) who felt free to express his disillusion with society by the leaving of it. The Sorrows of Young Werther, Goethe's novel about a sensitive youth who killed himself because of unrequited love, spawned a Werther craze and countless copycat suicides.

That less judgemental view of suicide had robust origins in the ancient world. The Greeks thought it a viable option, a rational response to life's dilemmas. It could be justified, Plato said, in cases of grave illness, hopeless poverty or profound grief. Aristotle was less liberal, but he left a canny loophole by famously saying: "The great-souled man holds that life is not worth having at any price." The Romans thought the hallmark of human liberty was a person's freedom to actively choose death. It was also an honourable way out of a tight political corner. Seneca took that route – as did a host of others, Pliny the younger, Brutus, Cato, Tacitus and Cassius amongst them.

It was Christianity that gave suicide a really bad name, but not until the early Middle Ages. The first Christians actively courted martyrdom and the glories of sainthood. Then St Augustine put his theological foot down by declaring that life was God's gift and that interfering with its natural course was a sin. Aquinas went one step further: he argued that, as man was made in the image of God, self-murder was a blasphemy against God himself.

This trenchant doctrine laid a dark shadow over the Middle Ages. Suicides were denied burial in graveyards, interred instead at common crossroads as a warning to others. They could be hanged for their crime. (As Peter Singer put it, "ideologues lack a sense of irony".) Their heirs were cut off from inheritance. They were the moral equivalent of lepers, shunned and dreaded.

The Renaissance opened the debate up again. A youthful John Donne dared to question whether suicide was a sin at all, or truly contrary to the laws of nature – was not Christ's death a form of suicide, as he could have prevented his own Crucifixion? (This was not an argument Donne pursued when he became a clergyman later in life.)

As the Enlightenment took hold, suicide returned to the intellectual agenda. Montesquieu, Voltaire and Hume wrote defences of it. John Stuart Mill argued that the taking of one's own life was a private matter, and certainly not the business of the state: "The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others. His own good, either physical or moral, is not a sufficient warrant."

The anti-suicide camp, which included Rousseau and De Toqueville, responded vigorously, but no longer in terms of Christian dogma. Now the argument was about social cohesion; suicides, by rejecting the society in which they lived, were weakening its fabric and contributing to its decay. Ultimately, Rousseau said, suicide was a socially irresponsible act.

Suicide as political insubordination has echoes for our own time. I'm not thinking of Buddhist monks who burn themselves to death or political prisoners on hunger strikes so much, but the political content of less spectacular and public suicides. To say "Life is not worth living, I do not value it as the rest of you do" is the most subversive statement anyone can make. Followed by a willed removal of the self, it constitutes a devastating rejection of those left behind.

In current times, the concept of suicide-as-sin has waned. The Judeo-Christian prohibition still carries weight in some quarters, but mostly the horror of a mortal sin has given way to sorrow over an "avoidable" death. Now many religious people advocate a more compassionate approach. As the population ages, more and more people, religious and irreligious, are turning over the question of how they can legitimately control their own agenda and achieve a death with dignity.

 

NOT LONG AFTER my mother died, a friend of hers said to me: "Oh she was very depressed," as if that was the only feasible explanation for her death. "Yes she was," I said, "but she was also very consistent and logical about wanting to die."

In this psychiatry-ridden age, the word "depression" has robbed the suicide of access to dignity and rational thought. It is assumed that only the depressed would contemplate a self-willed death. But there is, I think, such a thing as the suicidal vision. Suicides don't necessarily give way to a blank despair that deprives them of their powers of thought. For them, death makes profound sense; life's meaninglessness has finally found its logical solution. A suicide can be the very opposite of depressive; the depressed person sees no way out and is mired in inaction. Someone who is in the grip of the suicidal vision has found something they can do.

Yet suicide as a legitimate option is usually missing from the discussion. Sylvia, the recent film about Sylvia Plath, had nothing to say about the suicidal vision. A viewer who knew little about Plath would be forgiven for thinking that she killed herself solely because of her husband's infidelity. There was little sense of her intellectual and creative life, and no hint that she'd tried suicide long before she'd even met Ted Hughes.

There's no doubt that Plath was suffering acute emotional distress on the day she left bread and milk for the children, then went downstairs to the kitchen and put her head in the oven. Yet her friend, the critic Al Alvarez, who saw her regularly in those last months, portrays her as brisk and bright, efficiently caring for her kids, writing pre-dawn before they woke, hugely creative and productive. On the surface, she was functioning well, neither depressed nor insane.

Even when depression is clearly a component of the suicidal wish, it does not necessarily invalidate it. There can be good reasons for feeling depressed, and often – dare I say it – good reasons for wanting to kill oneself. Alan Kellehear, a professor of palliative care at La Trobe University, says depression is often used as "character assassination" and he doesn't like it: "I'm quite happy to make decisions when I'm depressed ... Who says you make better decisions when you're happy? ... There's nothing rational about wanting to kill yourself. There's nothing rational about wanting to stay alive either, actually. You're alive because you've got good social reasons to do so and you want to die because you've got good social reasons to do so."

I think of Violet Dickinson, an old friend of Virginia Wolf's, who at a mere fifty-seven was contemplating the attractions of death. Woolf records this conversation in her diary:

She [Violet] told me she had no wish to live. "I'm very happy," she said. "Oh yes, very happy. But why should I want to go on living? What is there to live for?"

"Your friends?"

"My friends are all dead."

"Ozzie [her brother]?"

"Oh, he'd do just as well without me. I would like to tidy things up and disappear."

"But you believe in immortality?"

"No. I don't know that I do. Dust, ashes, I say."

 

IT'S NOT SO long ago – 1983 – that suicide ceased to be a crime. While in the Middle Ages you could be hanged for trying to kill yourself, barely twenty-five years ago you could go to an Australian jail for the same thing. We've progressed a little since. It's now perfectly legal to kill yourself, but if you ask anyone to help you do it, that courageous son, sister or husband will risk going to prison for up to ten years if they agree. It is a conundrum as to why a legal act should have such serious consequences for someone assisting in it.

It's also an anomaly in Australian law which puts compassionate judges in a quandary. One judge, sentencing a fifty-six-year-old man who'd helped his cancer-ridden wife to die, said: "Since the law continues to regard what you did as an offence, the denunciation of it and the deterrence of others remain elements in any sentence to be imposed. However, I do not believe that thoughtful members of the community, knowing all the facts relating to you personally and the unique circumstances of this tragic case, would regard your immediate imprisonment as necessary ... In my view this is a case where justice may be tempered with mercy."

He gave the grieving husband a suspended sentence.

When these brave men and women turn themselves in and face the law, as they sometimes do, a suspended sentence is the only humane solution. Generally the Australian public is in sympathy; between 70 and 75 per cent of them support euthanasia. But that figure, constant now for some time and across countries, does not interest our governments, despite the fact that we have an ageing population more committed than ever before to autonomy and independence. Since the Northern Territory pro-euthanasia legislation was overturned, no other attempt to legislate for euthanasia has come even close to succeeding, and neither political party shows the slightest interest in changing the status quo.

This is the horrible paradox of our times – an increasingly popular cause consistently ignored by those in power. For the politicians, it's too hard, there are too many toes to tread on – especially the sensitive toes of the religious right. As yet this is not a vote-winning issue.

I think, though, that it's just a matter of time. In one federally funded report in 2005, called Ageing in Place, many respondents talked about their fear of ending up penniless and in a nursing home. They volunteered their views on assisted suicide and euthanasia, despite not being questioned on these matters. One eighty-one-year-old respondent said: "I'd rather die than give up my independence. Euthanasia will be my choice so I can say goodbye at the time of my choice."

This eighty-one-year-old is typical of thousands upon thousands of old people whose wishes are being ignored. Our societal ethos is all the other way – we spend millions on keeping people alive, regardless of their preference. That's forcing an increasing number of old people, who have never taken a radical or law-breaking position in their lives, to become politicised. At a time when they had hoped for a peaceful old age, they're joining euthanasia societies to lobby for change, or risking prosecution in becoming active members of Exit. Recently some of them have formed self-help cells to manufacture Nembutal, otherwise only available to the well off and enterprising who can make the trip to Mexico to buy veterinary supplies.

 

LISETTE NIGOT WAS an eight-year-old determined to take matters into her own hands, and she became famous by going public about it. Nigot had long been determined not to see her eightieth birthday in. She was a former academic, and had an interesting and varied life on three continents. She was neither depressed nor ill; she'd just had enough. In her farewell note, she wrote: "The life of an individual, voluntarily terminated, is of small importance compared to the death statistics relative to crime, accident, war and other similar causes of human demise which are viewed by society as a whole with regret, but accepted with relative equanimity.

"Why is there pressure against helping or allowing people who have had enough of living ... to fulfil the longing for final peace?"

Before her death, Lisette Nigot had talked to Phillip Nitschke, and her note made her admiration for him clear. But he did not help her. She organised and executed her death alone.

This very public and seemingly rational death caused great consternation. What right had a woman who was not sick, depressed or otherwise unfortunate to make such a decision? Many condemned her, including the Prime Minister: "I have a very strong view that we should not be encouraging healthy people to take their own lives, no matter what age they are."

Others saw Lisette Nigot's death as symptomatic of our society's lack of respect and affection for the elderly who, neglected and lonely, might feel they have reached a "use-by date" – the implication being that if they had been surrounded by attentive and loving family, suicide would not have entered their heads. Perhaps. Perhaps not. My mother was surrounded by love and care. It made not a jot of difference.

There are many stories. Two weeks before Nigot's death, a healthy elderly couple living in a retirement village in Bundaberg, Queensland, committed suicide together because they could not face the prospect of surviving each other. In a famous case a few years ago, Nancy Crick made a pointed statement by inviting several friends to attend her and witness her last hours. All faced assisted suicide charges, but in the end no charges were laid. In 2001, Norma Hall, a cancer sufferer, drank morphine after failing to starve herself to death. More recently, Dr John Elliott went to Switzerland to die with the help of the organisation called Dignitas. Again, he publicised his own death in an attempt to further the cause of euthanasia.

There is no place in this essay for unravelling all the issues around euthanasia and assisted suicide, and debating how they are to be turned into effective legislation. Nor to canvass the familiar "slippery slope" argument with which the legislation would need to grapple: where do you draw the line, how to prevent greedy relatives getting rid of granny? But it can be done, given the will. Holland and Switzerland, among others, have come up with acceptable laws and their death rates have not shot up. These countries have confronted the dilemmas and found solutions that give individuals a measure of personal freedom – at exactly the time when having personal freedom matters so crucially.

In Australia, we've managed to pass abortion laws of which the majority approves, which still allow each person to make their choice according to their own finessed values or moral code. Why can't we do it for the end of life as well?

One reason is that our laws are still yoked to religious notions of the sanctity of human life. But only humanlife. Most of us kill animals for our food without moral qualms. Most of us put down our pets when they are old and ill, confident that it is the compassionate thing to do. There's a blind human-centric arrogance in holding that we must not to take our own lives or help each other die. It's hypocrisy too because people help each other die all the time. They've always done so, out of compassion and friendship – whether on the battlefield, in hospitals and nursing homes, or in the privacy of their homes. And most of the time, commanding officers, hospital staff, police or relatives simply pretend it hasn't happened.

How different things could be. Suicide could come out of its secret back alleys, out of its bleak loneliness. It would not have to be a secret if his mates helped a mortally wounded soldier towards a quicker death. It would not need to be a secret if a doctor, aware of a patient's suffering and knowing their exact wishes, increased the dose of morphine. There would be no secrecy needed if a mother or father asked for their child's help towards a longed-for death.

Instead, there would be celebration, compassion, joy – because a good end to life has been achieved. Just imagine how different things could be.


From Griffith Review Edition 17: Staying Alive © Copyright Griffith University & the author.

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