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Is Suicide Ever "Rational"?

Death of an 89-year-old who was not terminally ill raises existential questions

I always thought the British group known as SOARS chose a courageous name: the acronym stands for the Society for Old Age Rational Suicide. The idea behind SOARS is that for some people in some situations, just being old can be reason enough to end their lives. 

Thinking it all through brings a knot to my stomach, as I try to imagine being at a crossroads, or watching my husband at one, in which every alternative leads, in one way or another, to death in the not-too-distant future. SOARS advocates for the right to die for old people who are not terminally ill -- but in a way, of course they're terminal. They're human and they're alive, and life is a finite, terminal condition.

Last week, an 89-year-old woman who's a member of SOARS went from her home in Sussex, England, to the clinic in Switzerland run by the group Dignitas, where she could receive a lethal dose of barbiturates and take them with a beloved niece sitting next to her, holding her hand as she died. (Dignitas calls it not assisted suicide, but accompanied suicide.) The woman wanted to be known only as Anne, and she apparently had been an independent, spirited woman her whole life, until some of the indignities of aging, including heart and lung disease, slowed her down. 

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Unfortunately, some of the press reports emphasize that Anne was annoyed and irritated by modern life and the interwebs, making her sound like little more than a cranky old lady. "Teacher died at Dignitas because she couldn't bear modern life," reads the headline in a report of her suicide at the Mirror Online. And the subhed: "Healthy spinster's despair at fast food, email and lack of humanity." It's not that different from some of the reports of another Dignitas patient, Oriella Cazzanello, an 85-year-old from northern Italy (and also, coincidentally, a "healthy spinster"), who chose to die because, as the Mirror Online put it, she was "upset about losing her looks." 

A report in The Independent had a slightly less provocative headline than the Mirror's in its story of Anne's death. It emphasized the reasoning that led Anne, a retired art teacher and Royal Navy engineer, to decide that her life had run its course:

In her application to Dignitas she reportedly described her life as “full, with so many adventures and tremendous independence”, but had recently found her strength and health fading and feared the prospect of a prolonged period in hospital or a nursing home. . . .

She told the Sunday Times: “They say adapt or die. At my age, I feel that I can’t adapt, because the new age is not an age that I grew up to understand. I see everything as cutting corners. All the old-fashioned ways of doing things have gone.”

The thing is, it might not be so crazy to think that if you're 89 years old, basically healthy, and tired of living, today is as good a day as any to die, since the alternative is to risk years of decline and humiliation and then to die anyway.  Anne's decision isn't even all that unusual. A few months ago, Mattias Egger at the University of Bern in Switzerland did a survey of 1,301 suicides orchestrated at Dignitas between 2003 and 2008, and found that 16 percent had been for people who were physically healthy. (A small number, about 4 percent, were in people who were mentally ill -- 41 people had a mood disorder, and 9 had another mental or behavioral disorder, listed as the underlying cause of death.)

This is the real challenge in the move toward assisted dying -- whether to allow it not only to hasten death in people with less than six months to live, as is required in the five states in the US where some form of assisted dying is legal, but to allow it in anyone who has decided that it's time to say goodbye. But how do you distinguish "rational suicide" in the aged from suicide in a younger person that grows out of pain, mental illness, and despair? And who makes that distinction? 

The truth is, I would like to be as strong as Anne if I reached a point where the only joy I had in life was feeding the birds in my garden, and where the only thing ahead of me was inevitable decline. I would like to think I could mount enough courage to bow out before things got too terrible for me or for my husband and daughters, who would have to watch me suffer and gradually disappear, possibly taking care of me in my dotage in ways that would diminish their joy in their own lives, and would color their feelings about me. Anne had never married and had only her niece to hold her hand, so maybe that's part of why she felt so ready to go. But in a way, maybe those of us with families are the ones whose old-age suicides might be truly "rational," leading us to bow out for the peace of mind of the people we leave behind. 

Robin Marantz Henig is a science journalist and co-author, with her daughter Samantha Henig, of Twentysomething: Why Do Young Adults Seem Stuck?

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