Suicide, assisted or not
Rev. Edmund Robinson
UU Church of Wakefield
March 17, 2002

	I was reluctant to do a sermon on suicide.  It is in issue in which I am deeply interested and cuts close to the bone with me, but I didn’t know whether anyone else struggled with these issues.  When I proposed this topic to the Board of Management, there was a hush in the room and then everyone said oh, yes, do it.  I speculate that most thinking adults have at some point considered suicide as an option for themselves, and sadly a great many of us have lost a close friend or relative to suicide.  I invite you if my words here stir up some deep feelings to come to the talkback after the service or come see me privately.
	I want to start with four stories.  The first is about a man I’ll call Ralph.  Ralph was an only child and as he grew up he was something of a lost soul. He drifted in and out of five colleges but never stayed long enough to earn a degree.  He dabbled in several business ventures with his parents’ money but nothing panned out.  His parents then died and he lived on the money they left him as long as he could.  Finally, at age forty, he found himself with no degree.  He would have to start a career ladder at the bottom rung when all of his high school classmates in the small town he lived in were raising children and salting away money for early retirement.  He went to a lawyer he knew to draw a will.  Two days after signing it, he drove out to the beach and breathed carbon monoxide until he died.
	Harry had a different story.  He had been a successful lawyer until he had a stroke which kept him from further work because it gave him an organic brain problem which led to a bipolar personality disorder.  He had no disability insurance, but worked out with his law firm an agreement that they would continue to give him a draw for ten years.  During that ten years he was a handful for his wife and the two younger children still at home; several times he had to be civilly committed to a mental hospital.  

	As he came to the end of the ten years his law firm had given him, it must have occurred to Harry that he was worth more dead than alive.  He had a lot of life insurance and no marketable skills.  He and his wife prepared to sell the big house they had raised their kids in and move into a condo.  Meantime, she had gone back to school and gotten a masters and was teaching.  Harry signed the papers selling his house and buying the condo, then left the bank and jumped off a parking structure.
	Then there is Beth.  Beth was bright and had graduated from Harvard and had a job as a paralegal.  She was very competent and seemed able to have complete control of thousands of facts in the cases she handled.  She didn’t talk much about her personal life at the office, but it turned out later that she was in a ten-year relationship with another woman.  When this woman left her, Beth also jumped from a parking structure.
	A fourth woman I will call Brigid, because she is Irish, the only Irish connection this St. Patricks’ Day sermon has.  She was forty-seven, and had lived with severe depression for many years.  She was unable to work.  There was nothing wrong with her physically, but she saw no meaning in life and every day was unbearable to her.  She saw a website on the Internet called Compassionate Chaplaincy, and started corresponding with its minister, who was a Unitarian Universalist.  He had helped dozens of people in her situation “self-deliver” as he put it.  She offered to pay his way to Ireland if he would help her end her life.  He and a companion came and visited the woman, spent a couple of days with her, and then helped her mix up a lethal potion of medications and sat with her while she took them.  They waited until she was dead and then left.  A media storm erupted.  Assisting a suicide is illegal in Ireland, and the Irish police are wanting to question this minister.  Brigid’s father gave a statement saying he was grateful to the minister for helping end his daughter’s suffering.
	As I said, this subject cuts to the bone, for I have a connection to all these events.  The minister who helped Brigid kill herself had served the Unitarian Church in Charleston when I joined that congregation, and I had been one of the principal lay people who asked for his resignation.  Beth the paralegal worked in the law office next to mine in Boston, and it was a few days after her suicide, as we were driving to her memorial service, that we learned of the attack on the World Trade Center.  I was the lawyer who drew up the will for Ralph, and had to administer his estate after he was gone.  And the man I called Harry was my father.
	Though I have had experience with suicides, it was the incident with the minister that inspired me to preach this sermon.  Indeed, the sermon comes about because his actions challenged me to think about what suicides I support and which ones I deplore.  As you will see, I will later conclude that this may be the wrong question, but let me start with him.  His name is George Exoo and he got involved in the question of assisted suicide by events in the Charleston church to which I was witness.  We had a man who was chairman of the vestry who developed cancer of the neck and jaw.  It came upon him very suddenly, and he became unable to communicate.  His wife knew he was in a lot of pain and tried to talk the doctors out of heroic measures which simply prolonged his misery but the doctors insisted that under the law they had no choice but to assist him to live as long as possible.  He lingered for months in agony, and after he died, his wife went on a crusade to get the state legislature to pass a Living Will bill so no one else would have to suffer.  George supported and helped her in this, and when the bill passed, we all celebrated.  I offered to do living wills for anyone in the church for free.
	After leaving Charleston, George started the organization I mentioned called Compassionate Chaplaincy.  He goes around the country helping people who wish to, as he puts it, “self-deliver.”  I don’t know exactly what his criteria are.  He once called me up to discuss a woman in Wakefield who had contacted them, and he concluded that she was not ready for their services.  So he does have some standards.  
	However, I am clear that George’s standards are considerably more relaxed than the assisted suicide standards in place in the State of Oregon and in the Netherlands.
	In order to be eligible for assisted suicide, Oregon’s Death with Dignity Act requires that a patient must be: 

·			An adult (18 years of age or older), 
·			A resident of Oregon, 
·			Capable (defined as able to make and communicate health care decisions), 
·			Diagnosed with a terminal illness that will lead to death within six months. 

Patients meeting these requirements are eligible to request a prescription for lethal medication from a licensed Oregon physician. To receive a prescription for lethal medication, the following steps must be fulfilled: 

·			The patient must make two oral requests to their physician, separated by at least 15 days. 
·			The patient must provide a written request to their physician, signed in the presence of two witnesses. 
·			The prescribing physician and a consulting physician must confirm the diagnosis and prognosis. 
·			The prescribing physician and a consulting physician must determine whether the patient is capable. 
·			If either physician believes the patient's judgment is impaired by a psychiatric or psychological disorder, the patient must be referred for a psychological examination. 
·			The prescribing physician must inform the patient of feasible alternatives to assisted suicide including comfort care, hospice care, and pain control. 
·			The prescribing physician must request, but may not require, the patient to notify their next-of-kin of the prescription request. 

	As you can see, the Oregon scheme is well thought out and narrowly applied.  Actually the latest reports are that only about 44 people requested assistance under it last year, and only 21 of those followed through.
	There is vociferous opposition to schemes like Oregon’s, and initiatives like this have been defeated in other states.   You may have read that Attorney General Ashcroft is attacking the Oregon scheme by threatening physicians with prosecution under federal drug laws.  So much for states rights, an altar at which conservatives worship when it seems expedient and which they discard when they need to.  I think I can stand behind this limited and controlled euthanasia.  I value the good death as an end to a good life, and would allow the dying and their loved ones to take some active intervention in the process of dying.  
	But outside the case of people who are medically near death, my ethical clarity falls apart.  The reason I gave you these stories is that my lawyer mind is trained to derive rules from specific cases, and these are the ones I have at hand.  
	The very field of sociology was in part founded on the discovery that suicide rates are as much a sociological phenomenon as they are psychological. Around the turn of the century, French sociologist Emile Durkheim found that single people were more likely to be victims than married individuals, Protestants more likely than Catholics, urban residents more likely than rural folks. Arguing that suicide was related to the nature of the bonds between self and society, Durkheim argued that either excessive or deficient levels of integration and regulation lead to four "ideal types" of suicide: 

·			egoistic: perhaps the most prevalent form in the United States, is the result of too little social integration, such as the suicide of a retired elderly widower; 
·			altruistic: the consequence of excessive integration, such as deaths of a Japanese kamikaze pilot during World War II or the self-sacrifice of an Indian suttee, where a widow throws herself upon her husband's funeral pyre; 
·			anomic: results from too little regulation or the shattering of one ties with society, such as with divorce or unemployment; 
·			fatalistic: this form is the result of excessive regulation coupled with high personal needs to control one's environment, as when a highly motivated college student takes his own life upon failing a critical exam. 

	At the other extreme from the terminally ill patient is the case of Beth, distraught because her lover left her.  I can’t justify her suicide, and would have done anything in my power to prevent it.  As I have mentioned before, I exchanged pleasantries with Beth about an hour before she killed herself, and have often gone back to wish that that conversation had taken a deeper turn.
	I don’t doubt that her life did not seem worth living at the time she took her fatal plunge, but I would have like the chance to talk to her about how it was worth living then and how she might come to see this in the future.  She was bright, likeable, beautiful, and talented and there would be plenty of other opportunities for satisfying relationships if she would just give it a chance.
	I also would try to talk my client out of his suicide.  I am sorry that I didn’t pick up on his intentions when I was preparing his will.  Career and money are important things, but not as important as life itself.  His act clearly stemmed from a view of himself as a failure, a loser, and I can’t help thinking that if someone had been able to convince him he wasn’t a loser, he’d be alive today.
	Now my father’s suicide is a tougher case for me ethically.  I thought at the time that it was a magnificent altruistic act; he was getting himself out of the way so that my mother, who was in her mid-50's, could get on with her life and not be burdened by the care of a mentally ill husband.  I maintained this rosy picture for two decades until I got into ministry training and started looking at some of the anger I carry around.  I realized that I was very angry with my father for the traumatic way he left us, but the anger was hidden by my admiration for the nobility of his act.  One useful insight from this is that the depths of one’s personality can harbor several emotions at once, which are diametrically opposed to each other.
	At any rate, if I imagine myself on the ledge of the parking garage next to my father, I am trying to talk him out of it.  I would use whatever arguments seemed likely to work.  I would tell him how much his act would traumatize the rest of us for the rest of our lives.  I would tell him that I loved him.  I would point out the ways in which he ministered to people in his good periods, for indeed he had become a regular presence in the hospitals. sitting for hours at the bedside of people he barely knew.  
	But this case is harder than the other two.  There are good reasons, from his perspective, for him to get out of the way.   He is not going to recover the use of his brain the way it was before, and he and the family can look forward to continuing traumas from the mental illness which might be worse than the trauma of his suicide.
	Then we get into en even greyer area with the Irishwoman whom George Exoo helped.   She had nothing physically wrong with her, but was suffering excruciating depression which had resisted all drugs.  I imagine she lived every day with an enemy inside her own skull.  I can imagine this was very debilitating for her.  
	We see suffering and we want to relieve it.  This impulse is good and noble.  Yet I could not have brought myself to help her kill herself.  I would have wanted to make a pitch for living and if that failed, to leave her to her own devices.
	What I realize from this exercise are two things:  first it is very hard to draw a line, in the abstract, between the suicides of which I approve and those of which I don’t.  Second, there are so many dimensions of this other than the ethical that I wonder whether the moral approval of you or me or anyone other than the person contemplating suicide has any real significance.
I can imagine that if I put myself into the position of George Exoo, I would engage with the patient and learn abut them and my personal relation, my love, rather than abstract moral principles, would become the guide for my actions.  
	Indeed the question I ask myself is do I have a right to moral opinions in the abstract?  If I am not the one suffering, can I cast judgment on any avenue pursued by the person who is?  Or, as any one of these people might have asked me, whose life is it anyway?
	Whose life?  There is the heart of the question.  I respect autonomy, freedom.  It is part of the respect for the worth and dignity of the individual.  But in thinking about suicide, I am able to see that none of us is an island.  Each of us is interconnected.  Indeed, one of the chief factors of some types of suicide is the feeling of being disconnected.  
	But I would say to any of these people, it is mainly your life, you are the majority shareholder, but you are not the only one.  Each of us who loves you has a stake in your life.  You have the power to cut us off, but if you do it will injure us.  Suicide is not a victimless crime.
	Moreover, even if you are a very isolated individual cut off from family and friends, there is another stakeholder in your life.  You can call this stakeholder God if that language is comfortable to you, and you can call it X if not.  But you have to realize that you are not self-created.  None of us got here under our own steam.  We were birthed and raised by parents, and educated by teachers and others.  Our lives are gifts from someone else.
	Now it may be that you’d like to return the gift, to find that window which would accept a life that seems worthless to you and give you a refund.  But that is not how life works.  The gift of life is both a boon and a challenge.  The challenge is to see what you can make of it, and to accept the fact that it will never be exactly what you want and will never turn out as you expect.  The excitement is in the novelty.
	I respect George Exoo but I would not do what he is doing.   I am not pro-life in the absolute sense that a Roman Catholic is, but I think that my ministry requires me to affirm life when I can.  I affirm death as the end which gives meaning to life, and I affirm the ability of those whose death is imminent to take control of their deaths.  But as to those who want to die simply because life has ceased to be worth living, my interaction with them wants to be a witness for the value of life.
	This witness becomes challenged when the objective reasons for living appear small and the reasons for dying appear large.  But it is in these times that the witness becomes most valuable.  The darkest hour is just before dawn.  The light is not possible without the darkness.  A faith untested is shallow.
	For my friends, winter is surely turning into spring.  What looked hopeless, what looked dead, what looked utterly bereft of cheer and opportunity and love, one day will surely blossom again.  The green blade riseth, it bursts through the muddy earth and brings new possibilities.  Life is the greatest gift of all, and life us surely worth the living.
	Every self-inflicted death among us other than those of the terminally ill is a failure of the rest of us to get through this message.  2.9 percent of the population has attempted suicide, and 1% succeeds.  It is the eight-leading cause of death among Americans, and the third-leading among Americans between 15 and 24 years of age.  
	This is a tragedy of monumental proportions, and I think it is largely avoidable.  May we seek ever to stay connected to those we love, to offer connection to the lonely and discouraged, and to be witnesses for the value of life, even and especially in the face of death.
	Amen.