Toward a Theory of Morally Permissible Suicide

Toward a Theory of Morally Permissible Suicide

James Hayward - Student #11105097 (jameshayward@hotmail.co.uk)

University of Amsterdam MA Philosophy

August 2016

“As long as those who have nothing to do with psychology and psychiatry fail to pursue the goal that urgently promotes the conclusive recognition of the freedom to choose a voluntary death as an inalienable human right, things will remain as they are. Society will continue to ‘excommunicate’ suicides and attempted suicides under the malicious pretext that through the act they’ve carried out or planned they have given up all claim to communion with others” (Améry 1999, p.53)

Contents

Introduction 1

Sympathy for Suicide 5

- Reasonable suicide 6

- The construct of natural death 12

- Anomie 13

- The suicide’s perspective 16

Autonomy and Suicide 21

Moral Considerations 29

- The suicidal agent 29

- Persons in proximity to the suicidal agent 32 - Suicide, society, and dignity 34

- A duty to live? 37

Conclusion 39

- Permissible paternalism? 39

Page | 1 Introduction

The extinction of the indigenous Tasmanian aboriginal community was not simply a consequence of their peoples having been hunted “like kangaroos for an afternoon's sport”, it was caused by the fact that inhabiting “a world in which this could happen was intolerable to them; so they committed suicide as a race by refusing to breed” (Alvarez 1981, p.17). And who would blame them? Who could honestly find the moral justification to condemn an act undertaken in such impossible circumstances? This is the most intuitively sympathetic case of suicide I have come across and well illustrates that there surely must exist some locus of morally permissible suicide, although the currently prevailing attitudes toward suicide might cast some doubt on that claim. The existence of a widespread and deeply entrenched suicide taboo amidst contemporary societies is surely undeniable.

Suicide has long “been interpreted as indicating a dry-rot of the soul, as a perverse and pernicious setting-at-nought of all” (Hook 1927, p.174-5). Dante reserved the second circle of hell for suicides. Hume's classic essay on the subject could only be published posthumously and was immediately suppressed “owing to the scandalous bigotry and outrageous ecclesiastical tyranny that prevailed in England” (Schopenhauer 2004). Even today, White House policy prohibits “the President from sending a letter of condolence to family members of troops who die by suicide” (Daly 2010). Suicide, in our civilization, “is something one is ashamed of, something like sickness, or better, like poverty” (Amery 1999, p.20). However, this has not always been the way of the world, suicide has not always constituted the taboo, and 'obvious' immorality, that it does today.

Many might be surprised to learn that there is no explicit prohibition against suicide in either the Old or New Testaments. Indeed, there is mention of four suicides in the Old Testament, none of which receive derision or condemnation. Only in the sixth century did the Church legislate against the practice (Alvarez 1981, p.12). Indeed, historically there has been far less anxiety around the subject. Consider the Vikings and the promised afterlife in Valhalla that awaited those worthy of such reward. After a violent death in battle, the next most honourable route to Valhalla was suicide. By contrast, those who died a peaceful death in bed were eternally excluded (Alvarez 1981, p.15). And in the literature of antiquity, the suicide of Oedipus' mother Jocasta is presented as a dignified way out of an insufferable situation, indeed, “Homer records self-murder without comment, as something natural and usually heroic” (Alvarez 1981, p.18). The ancient Greeks absolved suicide of any strong emotive content, regarding it not with horror or terror but a cold, distanced, rationality; even Aristotle's objection to it was grounded in the impersonal utilitarian concern that suicide

Page | 2 deprived the polis of an otherwise useful citizen. Although the Romans were subsequently to reinvest emotion in the practice, they did so positively, making suicide an aesthetic endeavour, a “practical test of excellence and virtue” (Alvarez 1981, p.21). Roman law allowed for all rational acts of suicide - only the irrational suicide was punishable since he who would kill himself without good reason, would just as likely kill another without the same, and thus presented an unnecessary danger to all people (Alvarez 1981, p.22-3). The current consensus that regards suicide as an immoral act likely finds its genesis in early Christianity. The exculpation from sin promised by martyrdom proved too great an incentive among many early Christians, particularly the Donatists, who by a not incoherent logic, were apt to martyr themselves in earnest and by any means possible, thus hastening their absolution and eternal salvation (Alvarez 1981, p.26-7). Faced with a genuine threat to Christian populations, Augustine issued a proscription against suicide, invoking the sixth commandment, 'Thou shalt not kill', and arguing that if a person committed suicide to atone for their sins, they were illegitimately “usurping the function of the state and the church” (Alvarez 1981, p.27). Further, given that life was deemed to be a gift from God, refusal to live that life and bear the attendant suffering “proved only that one did not accept the divine will” (Alvarez 1981, p.27). Augustine was successful in recasting suicide as a heinous and immoral offence against God, and although criticism now tends to be presented in secular terms, the general perception of suicide has changed little since - “the teaching of Western religion since the time of Augustine has been a resolute condemnation of all forms of self-destruction, and the criminal legislation of various communities has reflected these sentiments” (Hook 1927, p.173-4).

But the expediencies of sixth century Christianity are no suitable ground for any moral judgement. Consequently, the purpose of this essay is to argue against the prevailing consensus that suicide is a necessarily immoral act, and to circumscribe a locus of morally permissible suicide.

The first half of this essay is intended to challenge the taboo against suicide, and bring the reader to a position where any prejudice has been dispelled, where they can feel sincere sympathy for the suicide, and are able to consider the notion of permissible suicide dispassionately. Here we will pursue four distinct lines of thought. First, we will entertain the notion of a reasonable, or rational suicide. Second, we will criticise the concept of a 'natural death', illuminating its constructed nature and challenging the preference that many would express for such a conclusion to life. Next, we will examine the concept of 'anomic' suicide presented by Durkheim in his classic sociological study of the phenomenon, that argues for the existence of external, social causes of suicide for which a suicidal person could hardly be

Page | 3 said to be responsible. Thereby we will challenge the dominant narrative that suicide is merely the action of a disturbed individual. Lastly, we will attempt to engender empathy for the suicidal perspective by considering the vivid account of a suicidal individual put forward by Jean Améry prior to his own suicide.

The second half of this essay will amount to an attempt to articulate the actual conditions of morally permissible suicide. We will begin with a consideration of the requirement of autonomy, before addressing the effects of both prohibiting and permitting suicide, as they apply to the suicidal individual themselves; to their friends, family, and loved ones; and to society at large, and the very notion of human dignity. Finally, we will briefly address the duties of the suicidal agent and the rights claims that may be made against them, at which point, we will be in a strong position from which to advance a theory of morally permissible suicide.

Before commencing we must pause for a moment to address the conceptual problem of determining what actually constitutes a suicide. Intuitively, it is a term that poses little difficulty for our understanding, but there can be ambiguities in ascribing the appellation. Consider the patient with a terminal illness whose prognosis gives them mere months to live. If they should flood their body with opiates are they really a suicide, are they really of the same kind as a person who throws themselves in front of an onrushing train? Or are they merely choosing death now over death soon? (Kupfer 1999, p.67-8) If one advances a definition of suicide that requires intent to die on the part of the agent, or even just knowledge that death will likely result, how would we be able to establish or measure such things? (Beauchamp 1980, p.70-1) Similarly, the distinction between actively and passively self-inflicted death poses problems. If a person receiving dialysis, finding their predicament unbearable, were to rip the tubes from their arm, their subsequent death might reasonably be termed a suicide. But what of the person who simply refuses to undergo dialysis in the first place? Suicide elides comprehensive definition in terms of necessary and sufficient conditions, since “suicides do not form, as might be thought, a wholly distinct group, an isolated class of monstrous phenomena, unrelated to other forms of conduct, but rather are related to them by a continuous series of intermediate cases” (Durkheim 1952, p.45).

So, like Wittgenstein's understanding of games as all falling under the auspices of a family resemblance, we would do better to work with what Windt terms an 'open-textured' conception of suicide, guided by the rationale that “because similarity is capable of degrees and variation, we might expect to find that some cases of suicide are paradigms, while others, though still genuine cases of suicide, exhibit various atypical characteristics” (Windt

Page | 4 1981, p.40). Indeed, it is the suicide himself, Améry, who best captures the essence - if such a thing exists - of suicide, and our intuitions regarding its nature: “there are ideas of voluntary death that are so different from each other that it seems only possible to say that their commonality consists in nothing other than the fact that a suicidal person is seeking voluntary death” (Améry 1999, p.5). Given that the theory of permissible suicide here advanced is to apply to all instances of suicide, that is, to apply as much to the suicidally depressive as to the terminal patient in great physical pain as to the self-sacrificing martyr, Améry's 'voluntary death' best picks out all those cases we here take as our object of judgement. With these conceptual clarifications attended to, let us begin by discussing the possibility of a reasonable or rational suicide.

Page | 5 Sympathy for Suicide

The moral permissibility or otherwise of most acts (or omissions) does not usually turn on the motive of the agent in question. Most often an arbiter’s concern is for whether an act harms, endangers, or impinges on the freedoms of others. A desire to be on time for work is an admirable disposition, but when it motivates a man to drive well over the speed limit, perhaps through a residential area or a school zone, we do not temper our disapprobation for an act that risks the safety and well-being of pedestrians and other road users alike. However, this is not always the case. Hence the existence of such crimes as attempted murder. Or consider perhaps, a more relatable if mundane example, the friend who lies about the quality of our latest haircut for the sake of our feelings. If we knew they were lying we might disapprove, ask them to stop, but, we would, at least to some extent, empathize with and be able to understand and make sense of their behaviour. We might still ultimately think such behaviour morally impermissible, but we will have occupied situations similar to theirs before. We can recognize the motivating force of not wanting to hurt somebody's feelings, and see how it could lead them to the act that it did. In fact, one very well might alter their initial moral evaluation.

It is really little more than a banal truism to posit that perception varies with perspective. As a sniper squints through his scope he spies a terrorist. He lies in the undergrowth perfectly still waiting for the right moment. Perhaps an ant crawls up his nose. Ten seconds later, twenty meters away, a freedom fighter is startled by a sneeze and alerted to the presence of a Western Imperialist. Banal as it may be it remains valid.

There exists a great deal of opprobrium for suicide, the act, and for the suicide, the person. From a simply evolutionary perspective this hardly defies logic. But to what extent is the perpetuation of the suicide taboo the product of a widespread ignorance regarding the thoughts, feelings, experiences and circumstances - that is, the totality of the perspective - of the suicide? It is easy to put oneself in the shoes of a friend and follow their line of reasoning through to the lie about my hair. It is, and not without good reason, a great deal harder to step inside the suicide, perceive the totality of their life as they do, and to draw the same conclusions as them.

Before attempting to differentiate the permissible from the impermissible suicide, we should try and give voice to the suicidal perspective. If we do accept that, at least sometimes, motivation matters, we are obliged to consider the reasons people do or might have for

Page | 6 committing suicide. The more compelling such reasons, the more room we are likely to find for permissible suicide.

First we will consider whether suicide can ever be defended as a reasonable course of action. Next we shall examine the constructed nature of the concept of a ‘natural death’, and consider whether there is really anything strange at all about wanting to control certain features of one’s own death. Subsequently, we should dwell on the notion of ‘anomie’ presented by Durkheim in his classic sociological study of suicide, and consider the effect that external social forces can play in motivating suicidal behaviour. Finally, we should make a concerted effort to appreciate the suicide’s perspective. There exists not a great deal of first person perspectives on actual suicide (after all, who would write them?), but two years after a failed attempt, and two years before his successful one, Jean Améry committed to paper an invaluable insight into the mind of the sincerely suicidal human being. By considering the arguments presented therein, we will come as close to actually articulating a suicidal worldview as is possible.

Individually these lines of argumentation might be insufficient to move the reader to sympathize with the suicide, but, it is hoped, the cumulative effect of these diverse approaches to understanding suicidal desires will be enough to demonstrate that at least some suicides are, if not thoroughly endorsable, at least understandable and possibly permissible.

Reasonable Suicide

Almost everybody lives for as long as they are able. Whether in comfort at home, or in some sterile ward populated by strangers, strapped in and hooked up to various medical apparatus. Such disparate modes of death assume a strange equivalency - equally passive, each demonstrating a meek deference to death’s own perverse sense of timing. But let us not slip into the complacency of accepting this as a necessity. The great Stoic Seneca did not, observing wryly that “mere living is not a good, but living well. Accordingly, the wise man will live as long as he ought, not as long as he can” (Seneca 1970, p.59). Whilst the Stoic worldview appeals to few people today, Seneca’s recommendations regarding death are as lucid and relevant now as they ever were. In living, we tend not to leave important things to chance - it would be remiss. If I want to sail the seas, I should choose an appropriate ship based on the relevant criteria. Similarly, if I wish to settle at a permanent residence, I will choose a house that suits my lifestyle and that has room for my family. So too, reasons

Page | 7 Seneca, “I shall choose my death when I am about to depart from life” (Seneca 1970, p.63). Naturally, the time to make such a decision is dictated by one’s ability to ‘live well’, for a man “always reflects concerning the quality, and not the quantity, of his life” (Seneca 1970, p.59). Once the possibility of living well no longer remains, Seneca enjoins us to make haste with suicide, because “just as a long-drawn-out life does not necessarily mean a better one, so a long-drawn-out death necessarily means a worse one” (Seneca 1970, p.63). This is especially pertinent since the would-be suicide’s death begins in some sense from the moment that the suicidal desire takes hold - a process of waiting commences. But if they are made to work to the schedule of natural death, they are left in a limbo of sorts. They are like a man who has decided to embark on a rather short and simple journey. One who has made his way to the bus stop at the end of the road, when all of a sudden an impenetrable fog descends and lingers indefinitely. The man will stand at the bus stop for the rest of his life, squinting into the mist in search of the headlights that will carry him to the place he longs to be. If he sees them coming, it is unlikely he will see them from very far off - he may have a few moments warning. But until the moment his resolve attains the requisite strength the remainder of his pitiable existence will be spent squinting into the mist. Such a man can only been said to have lived ill, and to have died ill. The pragmatic approach of Sidney Hook also derides mere existence, asserting that “we must recognize no categorical imperative ‘to live,’ but to ‘live well’” (Hook 1927, p.186), similarly concluding that “when life ceases to offer that which makes our activities meaningful and our purposes self-sustaining, the fatuity of bare living cannot but be poignantly brought home to the sensitive intelligence” (Hook 1927, p.187). Seneca and Hook demonstrate a composed and critical approach to living and dying, largely absent in most people, that implicitly recasts the tendency of the living to want to go on living at all costs as a morbid combination of status quo bias and a fear of the unknown.

A common disposition among the suicidal is a feeling of a lack of self-esteem. Darwall advances an argument that what is good for a person, or in their interests, is what it is rational to want for their sake. Further, it really only makes sense to care about a person’s good to the extent that one cares about a person (Darwall 1997). However, Velleman identifies that the suicidal person seems to lack a good or an interest, and that this is grounded in their lack of self-worth: “the reason why value accruing to you no longer seems to matter, however, is just that you don’t seem to matter, period. You have lost your appreciation for the value that things have in relation to your interest because you have lost a sense of embodying value in yourself” (Velleman 1999, p.610). On this account, “a person’s good has only hypothetical or conditional value, which depends on the value of the person himself” (Velleman 1999, p.611). Where a person does not place any value on themselves, no good can accrue to them. Rude health, strong relationships, and intellectual

Page | 8 stimulation offer no benefits, whilst poor health, isolation, and idleness have nothing to harm. Of course, in such circumstances our hope is that the person can be taught to value themselves, but we are not here concerned to prescribe suicide to those with low self-worth. Rather, we are only looking to demonstrate how suicide can come to be seen as a reasonable or understandable option under certain circumstances.

It is often argued that suicide is a permanent solution to a temporary problem. Perhaps this is indeed often the case, and it is certainly not the point of this essay to imply that it is reasonable to kill oneself at the first sign of trouble. Help is best sought, and hope is best invested in the uncertainty of the future - ‘in the morning, I may feel a little better’. But we live our lives probabilistically, and whilst a suicidal person may not experience such feelings in the future, by the same token, they may experience them even more intensely, in which case they will regret not acting on them sooner. They may also get no worse or no better, and so it will remain “true, of course, that one can always bear another day; so why not put it off? This argument, of course, can be used for every day, with the result that one never takes action” (Brandt 1981, p.123). Certainly, there is little wrong with asking the suicidal person to take a day, a week, a month to reconsider their plan, just as we would ask for example, a child who comes home from their first day at a new school crying to give themselves time to adjust and integrate before looking for alternative education establishments. But it would take a bad parent to see their child come home in tears every day and do nothing more than placate them with false-promises of how things will get better, much as it would take a callous person to see the suicidal person want for death every day, yet insist that they wait and see how they feel on a tomorrow that never comes.

In a similar vein, psychiatrist Eliot Slater implores us to always bear in mind that suicide itself is an act, a symptom, not a pathology in its own right, and that its prevention does no good to the suicidal person “if we cannot influence permanently for the better the state of mind that led him to his attempt” (Slater 1981, p.202). An experienced mental health professional, he accepts that a suicidal recurrent depressive can reasonably be viewed as a chronically sick person (Slater 1981, p.202-3). In an essay of remarkable candor, he asks us how we can “be sure that the impulsive psychopath, who has opted for death, is not really doing his best, both for himself and everyone else?”, and reminds us that with his death, the chronically sick man “ceases to be a burden on himself, on his family, on the health services and on the community” (Slater 1981, p.202). Whilst this may sound like a cold, pragmatic consequentialism, and we may be comforted more by health professionals who proclaim that they will do everything in their power to save their patient, Slater’s years of experience make him more apt than most to offer a realistic assessment of the prospects of the suicidal

Page | 9 person. Indeed, Slater talks of incurable physical or mental illnesses leaving patients in “conditions which doctors cannot mitigate, but can only try to render tolerable. A stage is reached at last, which to psychiatrists needs no description, to which death would certainly be preferable, but one which could have easily been avoided” (Slater 1981, p.203). Not only is Slater arguing for an instance of permissible suicide, but the failure or inability to countenance such an option at a much earlier time clearly strikes him as cruel and immoral.

Fellow psychiatrists Perlin and Schmidt Jr. caution that the correlation between depression and suicide may not be as strong as imagined. Instead, they suggest that apathy and “hopelessness may be a better indicator of intensity of current suicidal ideation and the risk implied thereby than depression” (Perlin & Schmidt Jr. 1975, p.149). Indeed, one psychiatry textbook describes how

strong feelings of detachment, repressed aggression, and dampened affectivity are perceived by many patients as the equivalent of emotional dying or death. Clinically these patients may appear apathetic rather than depressed [...] and see suicide as a release from or as the carrying out of an event that has already happened (Freedman, Kaplan and Sadock 1972, p.494).

If this is the case, surely we should be more inclined to view suicide as a process by which the body can be brought into a state of alignment with the mind. Of course, there is no particular reason to prefer this course of action to one by which the mind is made congruent with the body (which would be the ideal course of action). The point, however, is that these two potential courses of action are not radically opposed, but different sides of the same coin. It would be optimistic to suppose that all those who had mentally detached from their life in this way could be revived, motivated to see themselves as a living human with a future, and so for some suicide will allow at the very least a harmonious conclusion to a disjointed existence.

Lastly, let us consider the recommendation of another psychiatrist, Motto, who argues for only two caveats to a right to suicide. First, that the decision to commit suicide be based on a realistic assessment of the life of the agent in question, and second, that the decision is taken with a minimal degree of ambivalence (Motto 1981, p.213-4). Motto is rightly troubled by the impossibility of determining what constitutes a ‘realistic assessment’, but this concern is outweighed by his acknowledgement that “every person’s perception is reality to him, and the degree of pain experienced by one can never be fully appreciated by another, no matter

Page | 10 how empathetic he is. Differences in capacity to tolerate pain add still another crucial yet unmeasurable element” (Motto 1981, p.214). Motto’s imperfect solution is to use the psychiatrist’s perception of the patient’s reality as the yardstick against which to measure the patient’s own. Although it is difficult to justify the absolute privileging of the psychiatrist’s perception, the hope is of course that the psychiatrist’s training makes them best suited to separate reality from distortion and detect the effects of cognitive biases. However, the important point is that he would rather leave the door open to permissible suicides, knowing that some he would deem impermissible might slip through the gap too, rather than close the door and leave so many suicidal persons in pain, twisting in the wind.

Whilst I have attempted to paint the desire to die at one’s own hand as something that can be rational, reasonable, or at least not entirely beyond comprehension, it might be objected that suicide is an inherently irrational act. Rationality, so the argument goes, “is all about protecting and promoting one's needs and interests: and how could it then be rational to destroy the very bearer of those needs and interests, and to destroy the possibility of protecting and promoting them in the future?” (Cowley 2006, p.498). First, this line of reasoning rests on an assumption that to live is better than to not live. There are two problems with this assumption. On the one hand it is an attempt to compare two incommensurable phenomena. Existing and not existing are not two sides of the same coin, they are qualitatively different. On the other, it involves a judgement made in total ignorance. It is logically impossible to know anything about a state of non-existence - it cannot be experienced, observed, or even meaningfully conceived of in any sort of way comprehensible to human cognition. Whilst it may be ordinary or sensible, not to mention evolutionarily expedient, to prefer existence to non-existence, it is intellectually dishonest to ground such a preference in an appeal to reason. Second, where this viewpoint is encountered, it seems unlikely that any amount of persuasion would be sufficient to move the interlocutor. In which case we might suggest that rationality is just not the right concept with which to appraise suicide. One avenue of faulty reasoning views a suicide’s death as “bad because we compare it not only with the life the person would actually have had (relative to which the death seems good), but also with other, more desirable futures that the person could have had but would not in fact have had” (McMahon 2002, p.466). We can see then, that rationality is a future oriented concept - the rational act offers expected future utility, the irrational, disutility. Judgements of rationality presuppose a future in which the consequences of some decision are to be enjoyed or suffered, but the suicide “is a man quite literally without a future” (Cowley 2006, p.500). Not only is it a future-oriented concept, but it is a self-oriented concept too. It is irrational to do certain things or make particular decisions because of the consequences for one’s self. However for the suicide, such

Page | 11 consequences are absent, since there will be no self to suffer them. A variation on this line of argumentation instead views the suicide as adopting a fundamentally nay-saying attitude toward the universe. By contrast, a yea-saying attitude is required as a precondition for any and all values (that is, not mere moral values, but also, for example, aesthetic ones). But the suicide cannot be philosophically praised or blamed, since “philosophizing implies the acceptance of cognitive values which are based on an affirmative stance and therefore cannot be used to arbitrate in the choice between affirmation and negation” (Clements 1981, p.105). The kind of cognitive values needed for the appraisal of morality or rationality just do not function for the suicide - they have no meaning, no power; in some sense, they do not exist for them. While the logic of the suicide may remain a mystery to some, it is hoped this present digression has at least demonstrated that suicide is not an intrinsically irrational act.

It might instead be objected that the putatively reasonable suicide is in fact the mere product of fallacious reasoning, or of false desires. Austrian psychiatrist Erwin Ringel, a man whose life was dedicated to suicide prevention, claimed that “anyone who has given serious scientific consideration to the problem of suicide knows that death - the state of not being - is for the most part chosen under pathological circumstances or under the influence of diseased feelings”, and that therefore “suicide cannot really be ‘chosen,’ since an intense, overwhelming inner compulsion renders any free ‘choice’ null and void” (Ringel 1981, p.206). Whilst I am disinclined to deny as a matter of fact the autonomy of the suicidal person, it does seem fair to suggest that they are more prone to errors in reasoning than the non-suicidal. Certainly there is a tendency to imagine and dwell on negative potential futures rather than positive ones. Such people also demonstrate a failure to correctly estimate probabilities, like the jilted lover who cannot fathom the possibility of sharing such romance with anyone else ever again - to a suicidal person Miss Havisham appears as the rule rather than the exception. The potential suicide is also liable to fall victim to the ‘goal gradient’ phenomenon (although this is more a general quirk of human psychology than a specific failing of the suicidal disposition) whereby temporally proximate events exert a greater motivational force than more distant ones, so “present unpleasant states weigh far more heavily than probably future pleasant ones in any choice of world-courses” (Brandt 1975, p.71-2). While these are reasonable objections to at least some instances of suicidal desire, they are hardly sufficient to rule out the possibility of sincere suicidal desire. What is more, even where we strongly suspect the influence of faulty reasoning, “knowing that the machinery is out of order will not tell us what results it would give if it were working” (Brandt 1975, p.72). We have then, it seems, reason to be doubtful of the sincerity of specific suicidal desires, but not the notion of sincere suicidal desire itself.

Page | 12 The construct of natural death

Let us change tack now, and consider the notion of ‘natural death’.

Considering that we all of us have to die one day, it is truly remarkable that we should not wish to choose for ourselves the most suitable and convenient time to do so, but instead put that moment off for as long as possible, no matter what the penalties (Slater 1981, p.199-200)

Slater poses a reasonable conundrum, but one that can be quite simply explained by reference to the notion of a natural death. Suicide is held to be the antithesis of a natural death, but what exactly is it that makes a death natural? Does it require that the deceased be of a particular age? But what is unnatural about the death of a child from leukemia, unfortunate as it may be? Does it require the absence of a cause? But no death is really uncaused - talk of death from ‘old age’ is merely a saccharine euphemism for the unavoidable infirmities that accompany the aging process. Nobody lives forever, and no foolproof precautions can be taken against the eventual failing of some vital organ or cessation of some vital process. Death comes to us all, and the concept of natural death is primitive, erroneously teleological, and “a convenient fiction” (Wood 1981, p.152) that helps rationalize death in otherwise uncomfortable moments. Not only does the name set up a false dichotomy (really the distinction should be between ‘planned’ and ‘unplanned’ deaths), the specific nomenclature (‘natural’) carries perniciously normative implications. But what exactly would be more natural, or even preferable, about dying, say, at the hands of one’s own failing liver rather than as a result of one’s own free choice?

Former chairperson of the Voluntary Euthanasia Society (now known as EXIT) Mary Barrington likens planned death to techniques of birth control. We need not thumb too far back through the history books to find a time when it was normal, or even encouraged, for people to have as many children as possible - indeed in some parts of the world this remains a common, even necessary practice. But technological, economic, and societal change have allowed humans to dictate their circumstances of procreation. Contraception, IVF, and abortion are all common phenomena in advanced societies. Religious resistance aside, this seismic shift in the way the human race propagates has been largely embraced despite an evolutionary drive to have as many offspring as possible. It is true that people generally do just prefer to have more choice, but there are clearly more specific reasons for the success and popularity of birth control having to do with its utility in contemporary societies. Financially, it is prudential given the cost of rearing children. Contrast this with most of

Page | 13 history, throughout which children have been profitable, assets, a source of labour for a family. Similarly it has played a key role in the empowerment of women. It is much easier for women to assume professional and social roles and identities beyond mother and wife without having to forgo hope of one day having their own children. In the progress of the last few centuries humans have attained such mastery of their environment that they can take survival for granted. But this brings new problems for which we are not prepared: overpopulation of urban areas, unbalanced top heavy demographics, and pension crises. Why wouldn’t prolonged old-age also bring with it the lifestyle choice of suicide? (Barrington 1981, p.94-5) There is little ‘natural’ about the circumstances of a great many births, and those that are planned could hardly be said to be any worse for having been so, likely they are in many respects better. What beyond prejudice and fear precludes the adoption of such an attitude toward death?

Anomie

Let us now consider another alternative perspective that looks to render suicide intelligible - Durkheim’s conceit of anomic suicide. Constituting the first sustained methodological study of a social fact, Durkheim's Suicide attempts to diagnose the causes of the phenomenon, positing it to be a structural issue – that is, one whose causes have an origin external to the affected agent. Ultimately Durkheim proffers four subtypes of suicide and asserts that their causes lie in extreme degrees of social integration or regulation. Egoistic and altruistic suicides, he claims, are the effects of too little, and too great a level of social integration respectively, while anomic and fatalistic suicides result from conditions of too little, and too much regulation. Since it is our purpose here to present the act of suicide in a sympathetic light we will dwell only on the anomic suicide. For we all know, from the suicides we have encountered, perhaps in our lives or more likely in the media, that it is not unusual for a suicide to exhibit an extreme degree of social integration. Similarly, it takes little imagination to empathize with the fatalistic suicide desperate to exert some control over an otherwise overdetermined existence. Consider the prisoner, or the military recruit whose every waking moment is determined for them (hence the relatively significant suicide rates amongst prison populations and active military servicemen), or the celebrity whose public persona has taken over and dictates the course of their life. By contrast, the anomic suicide requires some explicating.

The anomic suicide is, for Durkheim, the end result of what he terms “disturbances of the collective order” (Durkheim 1952, p.246). Durkheim observes a positive correlation between

Page | 14 economic crises and the suicide rate (Durkheim 1952, p.241), but perhaps a positive correlation between poverty and suicide is unsurprising. However, during times of plenty (as determined by proxy measurements such as relatively low prices of staple foods) the inverse is not observed – the propensity to suicide is much the same as during austere periods (Durkheim 1952, p.242-3). This leads Durkheim to the conditional conclusion that “if therefore industrial or financial crises increase suicides, this is not because they cause poverty, since crises of prosperity have the same result; it is because they are crises” (Durkheim 1952, p.246). The positive effect of crisis on the suicide rate, can then be explained, according to Durkheim, by the concept of anomie.

Durkheim begins from the premise that no person can live a happy, or even sustainable life “unless his needs are sufficiently proportioned to his means” (Durkheim 1952, p.246). Where a person’s means are not sufficient to satisfy their needs they will experience pain, dissatisfaction, and displeasure. Under ordinary circumstances, acts that yield such results tend not to be repeated, and replaced with more beneficent activities. However, when the sum total of a person's life is the production of such undesirable dispositions, their impulse to continue living – and thus continue to harm themselves in these ways – is bound to atrophy. This degeneration of vitality is the manifestation of anomie within the individual and explains the increased tendency to suicide in societies in crisis. Let us now consider whether and how these circumstances, so dangerous to the individual, can be brought about by social forces.

We have already seen that existence cannot be sustained if a person's means cannot satisfy their needs. But a person's most basic, fundamental needs, are not so great, and people always construct for themselves needs beyond those whose satisfaction is enough for mere subsistence (Durkheim 1952, p.246-7). Nobody literally needs a cup of coffee to get through the morning, yet for some the deprivation of what might ultimately be termed a luxury, will be sincerely felt to cause an equal degree of unpleasantness as a morning spent deprived of a genuine necessity such as water. But such needs vary between people, and there is no particular limit to what a person might decide constitutes a need for them, “the proof being that they [needs] have constantly increased since the beginning of history, receiving more and more complete satisfaction, yet with no weakening of average health” (Durkheim 1952, p.247). Without some external restraint upon a person's needs, they become a source of endless torment, with each need replaced upon its satisfaction by another, slightly more difficult to attain. But limitless desires are definitionally insatiable, “being unlimited, they constantly and infinitely surpass the means at their command; they cannot be quenched” (Durkheim 1952, p.247). As a result of these limitless desires, all activity is in vain, since it is impossible to advance toward a goal that is infinitely far away, and the torment is only made

Page | 15 worse by the satisfaction of a specific need since it provides only temporary respite, before it is replaced by a yet more urgent need whose satisfaction will prove yet more arduous. Eventually some insurmountable obstacle will be reached, and the disproportionality of one's means to one's needs will have a negative effect on the disposition of the individual, thereby increasing the likelihood of the tendency toward suicide. To avoid this some external limit must be placed on a person's needs, since alone, they are incapable of the requisite regulation (Durkheim 1952, p.248-9).

Is this plausible? Let us consider Durkheim’s account of how social crises lead to such a potentially fatal mismatch of needs and means. The reigning in of one's needs requires some external force, and, contends Durkheim, only society is apt to provide this stabilizing influence, since it is the only moral authority the individual will accept as sovereign over themselves. Durkheim’s observation that we all of us share a general idea about the kind of lifestyle appropriate for people of various social roles and professions to pursue seems fair. Indeed Durkheim asserts as a fact of social ontology that “a genuine regimen exists […] although not always legally formulated, which fixes with relative precision the maximum degree of ease of living to which each social class may legitimately aspire” (Durkheim 1952, p.249). This regimen gives rise to a set of equilibria, each pertaining to particular social roles, at the establishment of which, people are “contented with their lot while [stimulated] moderately to improve it” (Durkheim 1952, p.250). This distribution of social roles and professions is dictated and legitimized by hereditary fortune and merit, and maintained by a necessarily just discipline, since it “can be useful only if considered just by the peoples subject to it” (Durkheim 1952, p.251). Under the sustention of such social equilibria, needs and means are appropriately proportioned, and the phenomenon of anomic suicide is exceptional.

However, in the event of some crisis, or beneficent but sudden transition, society is no longer able to exert this stabilizing influence, as evinced by an increasing suicide rate (Durkheim 1952, p.252). Consider the example of an economic crisis which throws many people into a lower state than they had previously occupied. In such circumstances people must adapt their needs to suit their lesser means, they must learn greater self-control, practice humility and contentment. But the moral force of society “cannot adjust them instantaneously to this new life and teach them to practice the increased self-repression to which they are unaccustomed. So they are not adjusted to the condition forced on them, and its very prospect is intolerable” (Durkheim 1952, p.252). The establishment of new equilibria takes time, but in that time, social regulation is lacking, what are just and unjust, legitimate and illegitimate, go temporarily undetermined, and “consequently, there is no restraint upon

Page | 16 aspirations” (Durkheim 1952, p.253). Under such conditions the power of traditional rules weaken and there is a greater intensity of public life. People sense an opportunity to ascend to a plane of greater means and “the richer prize offered these appetites stimulates them and makes them more exigent and impatient of control. The state of de-regulation or anomy is thus further heightened by passions being less disciplined, precisely when they need more disciplining” (Durkheim 1952, p.253). We have already described the perils of excessive ambition and unrestrained needs – but this is amplified in a society characterized by anomie where so many people, each with their own runaway needs, come into violent competition with one another. And so “effort grows, just when it becomes less productive. How could the desire to live not be weakened under such conditions?” (Durkheim 1952, p.253).

It is worth clarifying that on this account anomie is not so much a direct cause of suicide as an aggravating factor, a part of one potential causal mechanism for suicide. Under conditions of anomie, other more direct causes of suicidal desire are far more likely to influence an individual and subsequently the individual is more likely to give in to the compulsion to commit suicide. Hopefully it is clear that we have dwelt on the concept of anomic suicide so as to demonstrate that any given suicide may be to a greater or lesser extent determined by external social forces. Many people find it hard to sympathize with the suicide because, they contend, they would never countenance such a course of action themselves. However, what Durkheim’s analysis of anomic suicide shows is that suicide is not always and exclusively the product of agentive action but can have at least significant contributory causes external to the agent, who becomes in such situations, to some extent a victim of circumstance rather than a mere unqualified suicide.

The suicide’s perspective

We will now conclude this attempt to render suicide sympathetic by presenting, as far as is possible given the limitations of the medium, the suicidal perspective. Jean Améry's On Suicide was first published two years after a failed suicide attempt. Two years subsequent to its publication he was successful. As such, the book's five contiguous essays offer a unique glimpse of the psyche of a suicidal person, and it would be at best remiss, if not intellectually arrogant, to fail to consider the discourse on voluntary death that Améry presents.

Given all that I have just said it is somewhat ironic that perhaps the point Améry is most anxious to convey, is that the suicidal perspective is one that can never be entirely satisfactorily communicated. In a metaphor that he returns to regularly, Améry describes the

Page | 17 mind of the suicide as “a darkness that can never be completely illuminated” (Améry 1999, p.2). The inaccessibility of other minds has, and will likely forever remain, an epistemic intractability. Even the best evidence based theories, hypotheses, and speculations of psychiatrists and psychologists regarding the lived experience of the suicide can never amount to concrete fact, because “what does it [science] know? Everything that can be known from the outside, that is, nothing” (Améry 1999, p.9). Given this, it really is impossible to berate or castigate the suicide with any degree of certainty or absolute justification, to claim that their action was undoubtedly immoral or that their situation was really bearable after all, if only they would have made a little more effort. Of course this line of reasoning flows both ways – how can we ever know that a suicide's life was really intolerable? But we are not here concerned to argue for the permissibility of all suicides – it seems likely that at least some of those who die by their own hand make a hasty and morally indefensible choice. But for each reckless suicide, there may be another who sincerely found life unbearable, and since we cannot know with the requisite certainty, we must always entertain the possibility. That it is hard, impossible even, to see the world as the suicide does, is not however sufficient justification to make no attempt, and testimonies like Améry's can only help. If we wish to have anything normative and of value to say regarding any issue, we must first make an effort to understand the opposing perspectives on it. However Améry diagnoses a widespread failure to attribute any value to the suicide's perspective, since it is “neither socially acceptable nor accessible to psychology” (Améry 1999, p.47). We must attempt to avoid this, but what would it mean to value the suicide's perspective? Once again, it is to recognize that whilst to us their existence may appear tolerable, ultimately, for them (as for all), perception is reality:

The ‘proportions’ are measured by society. But in addition everyone still has his or her own measure at hand. My judgement, insofar as it does not call into question the totality of all experience, finally has to be recognized as the valid one. I am in a position to say: ‘The incident that seems inconsequential to all of you may certainly be such to you, that I don’t deny; but for me it is a decisive event in life, decisive enough that on its account I’ll give myself death.’ (Améry 1999, p.57)

It may seem so obvious as to be barely worth pointing out, but an important facet of the suicidal disposition to bear in mind, is that the suicide is unable to see a future. When most of us experience negative feelings, our experience of such situations enables us to at the least look forward to a time when our life will be characterized instead by positivity, or at least, a decrease in negativity. But for the suicide this is not so. Améry tells the story of

Page | 18 psychoanalyst Paul Federn, a man who had recently lost the woman that was his companion, who suffered inoperable prostate cancer, and who eventually reached for his revolver as “there was nothing left to come his way except bodily pain and loneliness: what we call a future was blocked. And so he turned a nonfuture, which would have meant a life entirely enveloped in death, into something clear, into death itself” (Améry 1999, p.6). Since the suicide sees no future, it is hardly surprising that they do not view their act in the same light an outside observer does. The observer bears witness to the consequences of a suicide, the devastation and despair wrought upon friends and family members, but, having no future, the suicide's final act has no consequence for them. In the words of a suicide, “I die, therefore, life and everything there is as far as judgements are concerned has no value” (Améry 1999, p.27).

Not only does the suicide see no future, but in observing their present life and reflecting on their past, they can only see it as characterized by what Améry terms échec, a word that translates as something like failure or defeat. Améry explains the feeling as akin to that which would be felt by the doctoral student who, after years of work and dedication, fails at the final hurdle, the oral examination, and is denied the doctorate that would have given meaning and value to the years invested in the endeavour (Améry 1999, p.42). The suicide experiences both échec in life – a feeling of failure to meet some specific standard – and the échec of life, that is, the inevitability of death lingering perpetually in the atmosphere, whereby the suicide's lived experience is like that of a builder who erects a house that collapses on him during the roofing ceremony (Améry 1999, p.47-8). Under the constant menace of échec,

voluntary death becomes for everyone everywhere a promise full of potential. For reflective persons at the end of their chain of thought a natural death becomes the most extreme échec. You have lived and it was for nothing, because one day the world that you’ve been carrying inside you, the entire world, will perish […] Isn’t it better to beat the blade that guillotines us all to the punch? To escape that échec, and the last one of all to boot, with a no that brings all rejoinders to silence? (Améry 1999, p.43)

Suicide exists, Améry goes on, “as an answer to échec, as an objection against life, which hides within itself its own échec and is its own denial. Life is therefore both an affirmation and a negation and is thereby absurd, no less absurd than voluntary death” (Améry 1999, p.51). So then, we can see that for the suicide, existence is failure personified, and death is no worse, preferable even, clearly. We would not enjoin a person in a failed marriage to stick

Page | 19 it out and enjoy the failure indefinitely – when they separate from their spouse we understand and are happy that they are taking the necessary steps to negate their unhappiness. Why should we view the suicide any differently?

Lastly, let us use the testimony of Améry to challenge the absurd but persistently encountered received wisdom that suicide is inherently cowardly, a received wisdom that only serves to exacerbate the suicide's condition. To be cowardly is to lack courage in the face of danger or difficulty, and to feel an unjustified sense of fear. Certainly the suicide experiences fear, but their fright is not that of a milquetoast. The suicide is

frightened of the nothingness that they want to take to themselves but that won’t embrace them, frightened also of the society that damns them (they are a part of a minority and thus virtually colonial slaves of life), the society that they know will set everything in motion to save them - or to express it in modern terms, that will put them in its pocket again (Améry 1999, p.48)

But ultimately the successful suicide overcomes this fear. And so, Améry asks “why do we make what is already hard enough for them even harder?” (Améry 1999, p.48-9). It is a reasonable question. Given the potential future of a life lived in fear, suicide is surely a more dignified alternative? Perhaps it is not surprising to see the suicide cast as coward. Certainly suicides constitute a powerless minority group, maybe even “the last great outsiders” (Améry 1999, p.48), and they are hardly able to defend themselves from beyond the grave. But “it would be ridiculous to deny the effort of will that voluntary death demands of us” (Améry 1999, p.75). To deride the suicide as cowardly is an affront to language and a judgement that deserves no little scorn. Only for the simpleton, contends Améry, could there “be some kind of higher courage than the kind that defies the origin of every fear, the fear of death” (Améry 1999, p.48).

It is hoped that by now, any prejudices the reader might have brought to bear on suicide will have been, if not entirely dispelled, at least somewhat assuaged. We are then, in a position to entertain the notion of morally permissible suicide as something more than an exceptional occurrence. We need not let false notions of rationality, social constructs, ignorance, or the difficulties of empathy cloud our judgement. We need no longer view the suicide as inherently beyond comprehension, as an affront to nature and rationality, or even necessarily as someone entirely responsible for their own tragic fate. The case for permissible suicide has not yet been made, but a conceptual space in which to locate it has. We will now look to build such a case, taking as our foundation the concept of autonomy. How and why this

Page | 20 constitutes the minimal condition of morally permissible suicide will be the topic of our next chapter.

Page | 21 Autonomy and Suicide

If then, we are willing to concede that at least some instances of suicidal desire are rational, or reasonable, we can begin to search for the conditions that would make acting upon such a desire permissible. That we can sympathize with a particular desire does not entail that its manifestation would be morally acceptable. Certainly if all persons were to act upon any instance of suicidal desire, the resultant situation would seem to obviously constitute a morally deficient state of affairs. But let us not presume that there are no suicidal desires upon which it would be permissible to act. We can begin to differentiate between permissible and impermissible suicides by designating as the latter, any suicide that would be the result of an absence, or perhaps insufficiency, of autonomy on the part of the suicidal agent. That a suicide be autonomous, then, is the first condition of its permissibility. What this entails and why this is so will be the focus of this chapter.

Despite its significance to much contemporary moral philosophy, and the fact that many of us have a strong intuitive grasp of what a speaker means when they use the term, the question of the precise nature of autonomy remains vexed. The etymology of the word offers a useful starting point, being derived from the Greek stems for ‘self’ and ‘law’. The notion of the autonomous person as self-governing informs virtually every interpretation of the idea to some extent. This is often expressed in terms of acting in harmony with one’s own reasons, living in accordance with one’s own life plan, or being one’s own person. Although inherently a concept that elides specification, Christman seems to capture much of our intuitive understanding when he states that “to be autonomous is to be one's own person, to be directed by considerations, desires, conditions, and characteristics that are not simply imposed externally upon one, but are part of what can somehow be considered one's authentic self” (Christman 2015). However, to illustrate the ambiguity at play here, we might just as easily endorse Feinberg’s claim that autonomy denotes “the realm of inviolable sanctuary most of us sense in our own beings” (Feinberg 1989, p.27), despite the lack of any obvious overlap between the two formulations. Indeed, Gerald Dworkin has highlighted the many disparate ways in which the term autonomy has been used or interpreted:

It is used sometimes as an equivalent of liberty (positive or negative in Berlin’s terminology), sometimes as equivalent to self-rule or sovereignty, sometimes as identical with freedom of the will. It is equated with dignity, integrity, individuality, independence, responsibility, and self-knowledge. It is identified with qualities of self-assertion, with critical reflection, with freedom

Page | 22 from obligation, with absence of external causation, with knowledge of one’s

own interests (Dworkin 1988, p.6)

Aside from self-governance, many accounts of autonomy also stress the importance of the absence of manipulation and cognitive distortion. It is also to be distinguished from freedom, or at least from negative freedom, which we can understand as the ability to act upon one’s desires unfettered by external constraint. Autonomy however, is more generally concerned with whether or not the desires that move one to act are in some important sense really one’s own.

If, as seems likely, it is indeed the case that there merely exists “one concept and many conceptions of autonomy” (Dworkin 1988, p.9) then we are not engaged in a search to uncover the essential core of autonomy. We are not aiming to uncover the True meaning of autonomy and assess whether it is compatible with suicide. Rather, since “the value of a particular conception is always relative to a set of problems and questions” (Dworkin 1988, p.10), we are looking to articulate a defensible conception of autonomy that captures something intuitive about what it means to be self-governing, and that will allow us to differentiate between suicidal desire that is the result of proper self-governance, and such desire that cannot genuinely be grasped as, in a significant way, the agent’s own autonomous desire.

First, let us elucidate some of the important considerations and distinctions that many models of autonomy try and make. Then we will in turn detail four different conceptions of autonomy to try and discover if one, or some amalgam, is sufficiently suited to our purposes and able to delineate the autonomous suicide.

Many theories of autonomy require that an autonomous agent must be able to reflect on their desires and intentions, to be able to determine that they were acquired by legitimate processes rather than say, as the result of oppressive social conditions, propaganda, or ignorance. This requirement of procedural independence paints autonomy as “essentially historical, in that the conditions of desires and values that must be met for them to be autonomous are properties of the formation of those desires” (Christman 1989, p.9). It is commonly held that endorsing a desire or disposition even after this kind of reflection on its provenance is necessary to determine its authenticity, an important facet of autonomy, on some accounts.

Page | 23 Another important distinction is that between substantive accounts of autonomy - that is, those that are able to determine a priori certain desires or forms of behaviour as autonomous or non-autonomous - and value-neutral conceptions (Christman 2015). Substantive accounts find some specific desires or actions to be paradigmatically non-autonomous, for example, blind conformism to prevailing social norms. A value-neutral account on the other hand, preserves the possibility of an autonomous choice to be a blind conformist. We might worry that a substantive account would be likely to discount the possibility of an autonomous act of self-destruction, however, we might equally be concerned that the mere notion of a substantive conception is anathema to the very ideal of autonomy itself. Such concern is grounded in the idea that there is no necessary limit to the ways in which people can give their own lives meaning and that therefore “moral respect is owed to all because all have the capacity for defining themselves” (Dworkin 1988, p.31).

However, this apparent conceptual supremacy of content-empty approaches may not be so obvious, if it turns out that such a capacity obtains in meaningfully different degrees. Were this to be the case, we would be able to differentiate between instances of greater and lesser autonomy. But autonomy, it is often argued, is a concept that admits only of a threshold of competence, above which autonomy is secured in sufficient measure, and below which only heteronomy obtains.

We can also lastly note a distinction between what might be termed local and global conceptions of autonomy. The latter approach views autonomy as a characteristic of moral agents whereas the former sees autonomy more “as a property of preference or desire formation than a property of whole persons or of persons’ whole lives” (Christman 1989, p.13). Certainly for our purposes of passing judgment on a specific moral choice, we would expect a conception of autonomy that takes as its object decisions rather than agents, to prove more fruitful.

Let us now consider some actual systematic attempts to theorize autonomy and their pertinence to the particular moral dilemma at hand. We will begin by elucidating Kant’s classic formulation before turning to more contemporary interpretations with the model championed by both Frankfurt and Dworkin. We will also pay heed to Christman’s historical conception, as well as attending to the account of practical autonomy put forward by James Stacey Taylor.

The concept of autonomy owes a great debt to Kant, its significance being at least partly attributable to the central role autonomy plays in Kant’s moral theory. Kant “treats autonomy

Page | 24 as an ‘Idea’ of reason, attributed on a priori grounds to all rational wills” (Hill Jr. 1989, p.93), that is in practical terms, to virtually all mentally competent adults capable of rational thought. Kantian autonomy consists in “self-imposition of the moral law” (Christman 2015), which, in its most basic formulation, requires that an agent only “act in accordance with that maxim which can at the same time make itself into a universal law” (Kant 2002, p.55). What gives the moral law such impetus, and its autonomous quality, is the fact that our rational will is at once author and subject. It is an all-or-nothing notion of autonomy - either the maxim in accordance with which one acts is universalizable or not, but it is a feature of persons rather than decisions. Where one’s action does not conform to the Categorical Imperative, Kant takes this to represent a failure to properly express one’s autonomy rather than its mere absence. Although it offers a practical decision making heuristic, by equating autonomy with reason, Kant leaves no room for the kind of genuine choice and self-governance that we usually look to preserve by appeals to autonomy. While the idea of the self-legislating moral agent certainly does capture a great deal of what we usually mean autonomy to convey, the focus on objectivity “supports moral rectitude at the expense of genuine independence” (Feinberg 1989, p.36). We needn’t even speculate as to whether a Kantian conception of autonomy would preserve some loci of permissible suicide, for he confirms that it would not:

to annihilate the subject of morality in one's person is to root out the existence of morality itself from the world as far as one can, even though morality is an end in itself. Consequently, disposing of oneself as a mere means to some discretionary end is debasing humanity in one's person (Kant 1996)

Turning now to more contemporary approaches, let us analyze the notion of autonomy endorsed by the similar models put forward by Harry Frankfurt and Gerald Dworkin. This approach rests on the peculiarly human ability to form desires of the second order, which is to say that “besides wanting and choosing and being moved to do this or that, men may also want to have (or not to have) certain desires and motives. They are capable of wanting to be different, in their preferences and purposes, from what they are” (Frankfurt 1989, p.64). For Frankfurt, mere first-order desires are distinct from one’s will, which is an effective first-order desire, that is, a desire that moves one to action. And second-order desires are distinct from second-order volitions, the latter being a desire that a particular first-order desire be one’s will. It is, for Frankfurt, the having of second-order volitions that distinguishes persons from non-persons, and the autonomous person is constituted by “securing conformity of his will to his second-order volitions” (Frankfurt 1989, p.70). Rather than insist on the congruity of first and second-order desires, Dworkin’s formulation merely requires “the capacity to raise the question of whether I will identify with or reject the reasons for which I now act” (Dworkin

Page | 25 1988, p.15). However, this kind of reflection is necessary but not yet sufficient for autonomy, “for those reflections, the choice of the kind of person one wants to become, may be influenced by other persons or circumstances in such a fashion that we do not view those evaluations as being the person’s own” (Dworkin 1988, p.18). This account, then, requires also a procedural independence, the conditions of which remain to be spelled out, but that should serve to distinguish legitimate influence of critical and reflective capacities from illegitimate.

Although this approach gives no reason to discount the possibility of autonomous suicide, and is appealing in its intuitive simplicity, it is not without issue. Many commentators have pointed out that, if we posit the existence and significance of higher orders of desire, then we have no reason to stop at the second order. Indeed, if first-order desires are only legitimated as autonomous with respect to the content of second-order desires, it is surely intellectually incumbent on the subject to assure the autonomy of any desire at any level by comparing it against the content of the above level desire. For Frankfurt, this issue of infinite regress is avoided by what he describes as a ‘decisive’ identification between the first and second-order desires, an identification which “‘resounds’ throughout the potentially endless array of higher orders” (Frankfurt 1989, p.71). However, this philosophically ambiguous stipulation hardly seems to resolve the issue. We might reasonably, like Thalberg, “get the impression that Frankfurt has not so much answered the ‘regress’ challenge as forbidden us to raise such ‘questions concerning higher orders’” (Thalberg 1989, p.130). Dworkin allows for the possibility, in theory, at least if not in practice, for an infinite regress of higher order reflection. However this still fails to resolve the issue as “no matter how many levels of self we posit, there will still, in any individual case, be a last level - a deepest self about whom the question ‘What governs it?’ will arise as problematic as ever” (Wolf 1989, p142).

Perhaps instead, we might wonder what it is that secures the autonomy of the reflective process itself, because otherwise “we confront the very real possibility that the perspective from which evaluation takes place might itself be maintained heteronomously, thereby transmitting its heteronomy to the state under review” (Berofsky 2005, p. 59). Here Dworkin responds that he is “not trying to analyze the notion of autonomous acts, but of what it means to be an autonomous person, to have a certain capacity and to exercise it” (Dworkin 1988, p. 19-20), but again this seems more to avoid the concern than lay it to rest.

Christman offers a theory that aims at a historicized autonomy, one that acknowledges agents as both socially and diachronically structured. It is an account that requires competence - the ability to form and act upon desires - and authenticity, that is, assurance

Page | 26 that desires are truly the agent’s own (Christman 2009, p.134). Desires are evaluated in terms of their autonomy by “reference to the processes of socialization (or manipulation) that may have figured in the development of these desires” (Christman 2009, p.137). Christman looks to avoid the familiar charge levelled against procedural accounts, that they view social influence as an exclusively negative and corrupting force, ignoring the fact that “agents are socially embedded and seem to be at least partially constituted by the social relations in which they stand” (Mackenzie & Stoljar 2000, p.7).

The competency condition - the ability to form desires, act upon them, and critically reflect on them - is straightforward enough. The condition of authenticity, which requires ‘reflective non-alienation’, is a little less so. In this context, alienation denotes an agent’s judgement that some desire or disposition be repellent (an affective response), and a wish to change or resist said trait (Christman 2009, p.146). The reflective component of the condition requires critical self-reflection in “the agent’s characteristic mode of thinking and feeling” (Christman 2009, p.152), repeated in a variety of situations over an extended period of time, and absent any factor that might serve to distort or constrain such reflection. Christman’s position then, is that “when a person reflects on a trait over time and in a variety of settings and contexts, always yielding neither alienation nor rejection, such reflection indicates the kind of settled character that autonomous agency manifests” (Christman 2009, p.153).

Certainly Christman’s insistence that the kind of critical reflection relevant to autonomy should be an ongoing process seems to hit on something important. Often the idea of an autonomous agent is used to connote someone who lives their life and shapes their identity according to some coherent plan, and Christman’s temporally extended reflection captures this well. This stipulation also appears well-suited to appraising the autonomy of suicidal desires since suicide intervention is often justified on the grounds that such desires are likely to pass and be regretted.

This is hardly a flawless theory though. The importance placed on reflective self-criticism “tends to equate autonomy with self-transparency” (Mackenzie & Stoljar 2000, p.16), and autonomy becomes contingent on an awareness of the processes by which one comes to be as they are. But it seems highly optimistic to suppose that anybody is genuinely aware of all the forces acting upon them at all times - and if they weren’t, how would they know? (and for that matter, who would correct them?) Even supposing comprehensive genealogical self-knowledge, as with the previous model, this does not guarantee the autonomy of the reflective process itself. The notion of autonomy appealed to by theories that require a strong degree of procedural independence seems to be an unattainable ideal. It just is a