THEODORE

A. M c C O N N E L L

Suicide Ethics in Cross-disciplinary Perspective SUICIDE has long been the subject of research from the standpoints of causation, effects, and modes of prevention. A vast quantity of psychological, medical, and sociological material is now available, but systematic reflection about its ethical dimensions is considerably less extensive. And yet it is the ethical aspect of suicide that raises major issues for all pastoral care and counseling. Ethical judgment of the suicide is an area of critical concern just as it has long been a source of confusion within the histories of philosophy, medicine, and theology. The moral questions involved in suicide merit reconsideration in order that a model or series of models can be developed for use in specific contexts of care and counseling. One useful way to begin constructing such a model is to examine and evaluate the ethical perspectives apparent in the various disciplines that have turned attention to the problem. To consider suicide from the standpoint of moral discourse raises a number of issues, but central to these is the status of its truth claim. Is suicide to be seen in prohibitive and restrictive terms? If so, what are the structures supporting this proscription? Related to these questions is the total context of the suicide decision. Ought suicide ever to be attempted, and if so, under what conditions? A third point of inquiry seeks to ascertain the kinds of conditions under which the suicide decision is in fact affirmed. It is therefore useful to re-examine the implicit and explicit structures of moral discourse that the disciplines employ. This survey takes into account the generalizations of sociology, psychology, psychiatry, law, philosophy, and theology. The primary result of this is to demonstrate the kinds of moral discourse used about suicide and to seek some patterns for future direction of suicide ethics. Suicide Ethics

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Sociology The landmark of sociological research on suicide is that of Emile Durkheim. The essence of Durkheim's findings was that the incidence of suicide could be traced in a causal manner to the social conditions of the person attempting it. Durkheim's research reported generalized correlations of suicide with residence, marital status, economies, and religious ties. His work made a strenuous plea for the primary importance of social conditioning in the suicide decision. Subsequent sociological research has followed Durkheim's pattern and reinforced his conclusions. In a recent project involving a relatively controlled environment, Kobler and Stotland have concluded that a particular complex of field conditions must be present for suicide to occur. 1 But throughout the sociological investigations there is an absence of attention to the items of moral discourse. Specifically, the absence of bringing the discipline's tools of analysis to bear upon this dimension of suicide is notable. Perhaps there is implicit in work such as Durkheim's a form of moral discourse. That is to say, the implicit suggestion of such work may be that because suicide is largely the result of a field of inhibiting forces, it is not simply an issue of personal ethics. Suicide is seen within society as a whole, which implies that the conditions of society and their origins are the focal point for any moral discourse. And thus the role of individual decision is less significant in the evaluation process. The problem of individual freedom is not easily confronted, once this perspective is adopted.

Psychology and psychiatry In the course of extensive treatment of suicide conditions, psychologists and psychiatrists have evaluated all aspects of suicide, and it is not unusual to find moral implications and arguments within their literature. Freud viewed suicide as the result of extensive aggressive and guilt feelings contained within the self. The center for decision is the ego, which is the sole deposit of meaning patterns for life. Ego conditions are therefore crucial to any suicide decision. From this construct, Freud made what is in fact a significant ethical judgment regarding suicide. Suicide and murder were the same type of impulse action. Murder is aggression turned toward another, while suicide is aggression turned upon

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the self. Actually Freud's analysis contains an implicit value judgment: Murder is to be disapproved and prevented because it is highly destructive; suicide is identical in kind with murder; therefore suicide is to be highly disapproved and prevented. Subsequent developments in psychiatry have often resorted to this stance in seeing their principal task as one of prevention. Within the discipline a number of alternative patterns of analysis and implicit value judgments have become apparent. One methodology that is different from the Freudian perspective is that of Carl Jung and his followers. Unlike Freud's thought, the Jungian perspective does not use the ego as the only center capable of carrying a meaning pattern for life? There is the phenomenon of the self, which is a center for meaning and value patterns. While there must be contact and relationship between the ego and the self for the reality of meanings and values, the self is crucial to any decisions of this nature. The self has a bright and a dark side, according to the Jungian perspective. It is in the prevalence of the dark side that death may appear to be a more desirable value. The Jungian perspective has also stressed the significance of unconscious longings for rebirth as crucial to the suicide decision. In the Jungian perspective there is an assertion that value patterns, because they influence the character of the self, are of importance in the suicide decision. Harry Stack Sullivan classified suicide into two forms: those suicides that were the end product of various forms of clinical illness and those that resulted from mature, reflective behavior? The former are seen as "unfortunate." While he did not offer judgment or analysis of suicide in the second form, Sullivan clearly attached negative attitudes to suicides of the first category. Suicide that is the product of illness is a destructive activity, hostile and hateful in its tone. It may embody anxiety and envy. The psychiatric attitude to such suicide decisions is one of prevention and treatment whenever possible. Not unlike Freud, Sullivan found a negative value judgment in the destructive character of suicide. In contrast to the perspective of Sullivan and that of Freud, followers of Karen H o m e y have seen the suicide decision as a failure or lack of development within the self. There are no naturally destructive tendeneies within man, and thus the value judgment cannot have its locus in the implications of either individual or social destruction. 4 Rather, suicide is seen as undesirable because it represents a failure or lack of self hood. A significant shift of methodology can be noted in the personal conSuicide Ethics

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struct theory of George Kelly. Kelly's method is to look at the event of suicide itself in an attempt to ascertain what it accomplishes for the one who undertakes it. 5 For Kelly, the significant value issue in suicide evaluation is whether the event can be seen as a mode of validating life. This is an intricate form of argument, for its primary value assignment is to life. But it also strives to assert that under certain conditions the election of suicide is the only pattern for realizing this value assignment. Kelly finds that the significant data for evaluating the suicide decision are what the person died for and what constructs of life, truth, and anticipations were validated? Clearly the crucial issue in Kelly's structure is precisely how life is defined and approached. He finds the ordinary categories of analysis to be of little use, and therefore attempts to establish new ones. The significant value issue in this personal construct theory focuses upon whether the individual is trying to terminate or validate life. The former is rather closely approached by Kelly with negative attitudes. A variety of general situations are seen by Kelly as areas of positive approach to suicide. The first is the situation of "realism," in which the course of events has become so obvious that no purpose will be fulfilled by awaiting the outcome. The second is that of indeterminacy, in which everything is wholly unpredictable. It is not entirely clear whether the second category embraces a pattern of escape. Presumably it would not, but this is not made explicit. Perhaps the most forceful defense of the suicide decision in certain situations has been the work of the Jungian analyst James Hillman. He views the preventive presupposition of law, medicine, and theology as a major block to an adequate understanding of suicide. The principal focus of Hillman's work is the role of the soul, involving an implicit value judgment of approval for suicide. "If one stands for psychological life, as the analyst must, physical life may have to be thwarted and left unfulfilled in order to meet the soul's claims, its pressing concerns with redemption. ''7 Suicide is a way of entering death which itself "releases the most profound fantasies of the human soul. ''s In his distinction between types of life, Hillman is more explicit than Kelly regarding exactly what suicide might affirm and validate. Clearly Hillman is anxious to stress the positive attributes of suicide. His reasoning moves back and forth between the tools of analysis and those of metaphysical speculation without being entirely clear upon what basis there can be affi_rmative value judgment of suicide.

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This very brief review of the materials of psychiatry and analysis shows a variety of approaches to the problem of suicide. Much of the material exhibits a preventive orientation based upon an implicit negative judgment of suicide. Some atypical research, such as that of Hillman or Kelly, is intent upon discovering patterns of self-affirmation in the election of suicide. T h e lava

In the past, the law has dealt with suicide in prohibitive and restrictive terms. Glanville Williams has reviewed the various strictures and prohibitions against suicide in British and United States law? While British law has often been highly prohibitive, including forfeiture of property rights, Williams notes a contemporary trend of opinions against fixing penal attachments to attempted suicide. TM Norman St. John-Stevas has subjected the basis of prohibitive law of suicide to serious examination. He finds that the two principal lines of defense advanced for a prohibitive attitude are: x) its deterrent value and 2) its making treatment possible for the person. 11 He challenges the deterrent defense with some success in asserting that such law might well have the effect of strengthening the intention of suicide. The deterrent principle is therefore of sufficient ambiguity to remove it as a defense of prohibitive law. Similarly, St. John-Stevas finds that imprisonment may actually retard recovery. At the same time, it possesses no intrinsic abilities to prevent the suicide decision upon release. Thus prohibitive law is to be seriously questioned as an adequate legal approach to suicide. The general attitude of the law, even apart from the nature of prohibitive strictures, has been to view suicide as a form of murder. As Edmond Cahn has noted, the legal construct pattern has been that "Whoever kills himself kills a member of the human genus. He commits a homicide. ''1~ Since the law's attitude toward homicide is that it is a punishable crime unless the act is justifiable or excusable, the moral inquiry in this discipline hinges upon the definitions and conditions of justifiable and excusable. "Can self-killing ever constitute an act of selfdefense, which might make it morally 'justifiable?' ,,18 In a carefully executed pattern of analysis, Cahn saw the moral dimensions of the legal perspective with greater clarity than do most. Granted the basis and presuppositions of the law, suicide becomes justiSuicide Ethics

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fiable when it is the only possible way to save "the intrinsic self. ''14 In developing this argument, Cahn cited situations of dehumanization, debasement, and exploitation as ones in which a justification was possible. While the past history of law exhibits a disapproval of suicide, prohibitive legislation is a matter of decreasing use. The law is still relatively firm in its view of suicide as a category of criminal murder. But there is also a concern to specify situations under which this act might be termed justifiable. Philosophy The landmark in philosophical analysis of suicide is still David Hume's 1789 essay, On Suicide. In that essay, Hume contended that suicide is never a positive harm, but merely a cessation of the individual's ability to do good. As Sprott has observed, Hume was intent upon demonstrating "on empirical grounds that the action of suicide may be free from every imputation of guilt or blame. ''1~ In doing this, Hume advanced three arguments designed to counter the proscriptions against suicide: i ) Suicide is not in fact an infringement upon God and his order of providence, for it does not harm. z) Suicide is not a crime against society, because one may be quite unable to promote the interest of society. 3) Suicide is not to be seen as a crime against the self. In fact, it may well be in the self-interest whenever life becomes a burden through age, sickness, or some disaster. Thus Hume contended that the proper philosophical attitude toward suicide is never one of negative judgment or disapproval. In fact, there may well be various situations in which suicide promotes some positive attribute or good. In contrast to Hume's position, both Kant and Hegel contended against suicide under any conditions. For Kant, suicide is to be disapproved and prohibited because it degrades the humanity that exists in the person. For Hegel, suicide is a contradiction because it is not possible for the self to stand over itself and so determine its end. In both instances the nature of suicide as destruction is the locus of the value judgment. The late French philosopher Landsberg found weaknesses in the natural law and social good arguments, but he also disapproved of suicide. According to him, if suicide were in fact contrary to natural law, then it would only rarely take place. TM Similarly the argument against suicide because of the individual's social duty has little effect. If in fact one xz

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could find no social justification for his existence, then the opposite imperative would be upon him. lr He located the prohibition of suicide in a theological structure whereby men are seen as God's property and thus do not have an intrinsic right to self-destruction. The interesting missing dimension in Landsberg's use of this reasoning is that of the social-political. That is to say, if self-destruction is a trespass against divine property, then what is an adequate view of decisions and activities that make available instruments of mass destruction? Once the factor of destruction is isolated as a principal item of the discourse, this socialpolitical dimension becomes apparent. Within philosophical ethics there is an absence of direct and systematic reflection upon the problem of suicide. If there is any consideration given to the problem, it is most often of a cursory nature in contrast to disciplined ethical exercise. It is all too evident that the vast majority of philosophers have been content to deal with speculative principles of ethics while avoiding the concrete task and discipline of applying their generalized systems of analysis. For example, Sidwick, who held a position of note in the field of philosophical ethics in this century, argued in a cursory fashion against suicide. His argument was in terms of social duty and the nature of virtue, whereby suicide was seen as an escape from the conditions of life and a positive lack of virtue. TM Eliseo Vivas has opposed suicide on the ground that man does not possess this right. Vivas traces this right to divine freedom while man is said to possess a qualified and incomplete freedom? a Apart from generalizations of this nature, philosophy displays a notable lack of disciplined and extensive reflection regarding the problem of suicide. Even the so-called existential schools of thought, which emphasize nothingness and meaninglessness, do not approach the problem. This lack is of particular note in philosophers like Jean-Paul Sartre and Martin Heidegger. The existential novelists and playwrights such as Albert Camus have devoted considerably more attention to the issue.

Theology The philosophical lack of reflection about suicide is surpassed only by that of Protestant theology. In contrast, Roman Catholic moral theologians have devoted considerable attention to the problem of suicide. St. Augustine formulated a forthright opposition to all suicide. For him,

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suicide was counter to God's will, represented a decision that man did not have the right to make, and demonstrated an escape from the duties and problems of living. As Edward Westermarck pointed out, St. Thomas Aquinas opposed suicide by way of three postulates: i) It is against the natural inclinations of preservation of life and charity toward the self. 2) Suicide is a trespass against the community. 3) It is a trespass against God, who has given man life? ~ For St. Thomas, all life is a preparation for the eternal. His argument therefore stresses the sacredness of human life and absolute submission to God. St. Thomas' natural law arguments have formed the basis for Roman Catholic reflection on the grounds of suicide. There is no reluctance on the part of Roman Catholic theologians to deal with the moral dimensions of suicide. A wide range of recent Roman Catholic literature illustrates the continuing concern with suicide. For example, in developing general principles for medical ethics, Edwin Healy confronts the issue of suicide. While one of his major presuppositions is the human right to continue living, this is not seen as unlimited. It is precisely with respect to the problem of suicide that certain limitations are encountered. "This right of a human being to his own life, however, is not absolute and unlimited. In the first place, he is not free to end his life by suicide. ''21 Healy uses the first and third of St. Thomas' principles to formulate his stance. In another major Roman Catholic work, Henry Davis lodges strenuous objections to suicide. He finds it to be a violation of natural law and therefore of God's law. Suicide is objectionable because it prevents the attainment of perfection and the end of life. Moreover, it is a trespass against society of which man is intended to be a part. And finally, suicide blocks the realization of the divine purposes and interrupts the unfolding of God's design for the world. 22 Similarly, Thomas O'Donnell finds suicide an "evident invasion of the exclusive and absolute dominion of God in human life. ''23 He cautions medical people to give due weight to the implications of suicide in every evaluation which they are called upon to make. This is especially the case in the light of the prohibitive burial rite canons in eases of deliberate self-purposed deaths. There is a high degree of agreement within Roman Catholic moral discourse regarding suicide. St. Thomas' formulations continue to constitute the basis for reflection among a large majority of the materials. In contrast to the Roman Catholic materials, there is an appalling lack

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of Protestant theological reflection on suicide. Some of the most noted theologians working in ethics have never offered systematic reflection upon this concrete ethical problem. One exception is the work of Dietrich Bonhoeffer. Basically Bonhoeffer saw suicide as a sin in that it represents a denial of God. For Bonhoeffer, suicide was a form of self-justification even when it was executed in a situation of despair. One of Bonhoeffer's most carefully formulated arguments based the prohibition of suicide on the nature of human destiny. That is, it was his conviction that men do not know the ultimate good of their existence. Therefore, it is not possible for them to evaluate their present actions in terms of this goal. His clear implication was that present actions must somehow direct the self toward this goal. This is part of the divine work. Therefore, because suicide in ending life may actually block this direction, it is to be avoided: "God has reserved to Himself the right to determine the end of life, becauso He alone knows the goal to which it is His will to lead it. Before God self-justification is quite simply sin, and suicide is therefore also sin. There is no other cogent reason for the wrongfulness of suicide, but only the fact that over men there is a God. Suicide implies denial of this fact. ''24 Yet Bonhoeffer found some significant qualifications of his major argument. In those cases where there is a suicide in order to save the lives of others, he wanted to suspend any judgment. His principal reason for this was the assertion of a severe limitation of human knowledge in such instances.25 Within this suspended category, Bonhoeffer wanted to include those prisoner-of-war cases in which suicide is undertaken out of fear that knowledge given as a result of torture will result in other deaths or injuries. Thus the issues of motivation and the greater good become significant qualifying tools in Bonhoeffer's ethical discourse. While it is in general a matter that the conscience must disapprove and reject, there are significant qualifications that cannot be ignored. Another source of Protestant reflection on suicide is Helmut Thielicke, who shares Bonhoeffer's general rejection of suicide as a possible option for the Christian moral life. Thielicke finds the origin of suicide in a demand for certain specific securities and patterns of meaning. If these remain unfulfilled, the individual who cannot or refuses to accept the situation elects suicide. Quite clearly Thielicke is convinced that such a potential situation stands in need of correction and change. The Suicide Ethics

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corrective is seen as a right relationship to God and a care for the neighb o r . 2~

It is with respect to the social dimensions of suicide as a moral problem that Thielicke devotes major attention and provides significant theological reflection. While he lodges serious qualifications and makes careful distinctions, Thielicke finds a collective form of suicide in the contemporary world order. In developing his position, Thielicke cites the case of a patient who elected suicide and thereby replaced her own sense of emptiness with one of death. This suicide is seen as a turning of the passive condition of emptiness into a final act by personal intervention. Thielicke then asks, "Could it not be that this law, which is so obviously demonstrated in individual schizophrenia, also accords, on the level of super-individual forces, with the fact of the two World Wars? Are these anything but collective suicide attempts, expressions of a deepseated obsession with self-destruction? Is it merely speculation in the realm of the philosophy of history, to venture the interpretation that the discovery of the atom bomb is not to be regarded as the end-result of the operation of technological developments? May we not suggest that it was not accidental that it occurred at the very moment when empty, modern mankind was seeking this kind of physical confirmation of its feeling that it had come to the end of its tether, the very moment when Nothingness was thrusting it toward annihilation? ''27 In this kind of exceedingly broad depiction, Thielicke isolates the dimension of collective suicide and its moral problems. For him, any decision that moves the world order in this direction is a decision for suicide. Such decisions cannot be condoned within the Christian moral life. Thielicke bases his analysis upon the nature of nothingness and lack of meaning as a denial of God, whose collective and individual forms of suicide are its concrete expression.

The interdisciplinary perspective An examination of reflection within various disciplines on the problem of suicide shows a marked degree of disapproval in terms of the forms of moral discourse. Only within the discipline of philosophy have there been forms of approval. The disapproval within the various disciplines exhibits the widely different forms of moral discourse employed. The major arguments within sociology are based upon principles and

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convictions regarding the nature and value of communities and the individual's role therein. Within the disciplines of psychology and psychiatry, emphasis is placed upon the nature of the self and its preservation. The law often regards suicide as a form of murder and therefore as a subject for prohibition and restriction. But within each of these disciplines it is most significant that suicide is considered solely in terms of the individual variety, in contrast to Helmut Thielieke's definition. The three disciplines share a preventive basis of reflection for attitudes toward suicide. Theological reflection has also usually seen suicide in a negative manner. The arguments from natural law, the good of the community, the divine will, and the nature of human life as part of divine creation are frequently used in theological analysis. In contrast, philosophy and theology have the potential, both by induction and deduction, to examine critically the attitudes of all the disciplines with respect to suicide. This is a tool holding some promise for disciplined reflection on the ethical dimensions of suicide if it were concretely employed to interpret general principles of various systems of thought. Some indicators for the future direction of reflection upon the problem emerge from any interdisciplinary examination. Certainly both the individual and collective dimensions of suicide as an issue of moral discourse are in need of extensive careful and systematic analysis within all the disciplines. More attention could profitably be devoted to exchange among the disciplines. Specifically, the moral discourse of the various disciplines could more extensively consider the inductive and deductive methods of philosophy. This could prove to be a significant tool for re-examination and more elemental reflection upon the nature of the moral dimension of suicide. In a consideration of suicide, one becomes aware of the significance for moral discourse of the conditions under which the suicide was elected or is being considered. This points to the necessity for ascertaining what goals, if any, have conditioned the decision. These must then be evaluated in the light of any general principles that have been established as well as in terms of the degree of appropriateness of the decision for implementation of the goals. None of the disciplines has devoted sufficient attention to this form of analysis. Far too much emphasis has been placed upon broad, inclusive, and generally rigid proscriptions. Careful principles of distinction that take account of individuals and therefore have an Suicide Ethics

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element of flexibility in them can be highly useful in ethical reflection. The matter of discovering conditions and goals is, of course, an exceedingly intricate undertaking. The seeming motivations and conditions out of which a suicide decision arose may reveal something of why it was undertaken. Sometimes these are not readily accessible, even with the tools of psychiatry. But it is only after these areas have been explored that a full and systematic ethical analysis can be undertaken. It is significant that legal and theological analysts of the problem have generally been more inclined to explore the qualifying aspects than have sociologists and psychiatrists. However, none of the disciplines has adequately explored the ethical dimensions of suicide. Within their own structures of thought, Roman Catholic theologians have devoted major attention to the problem. Most basically the disciplines have failed to consider adequately what, in fact, are the ethical dimensions of this phenomenon. What is initially needed is a total methodology for ethical analysis of suicide.

Suicide: the ethical decision Granted the high degree of ethical disapproval of suicide among the various disciplines, one of the crucial issues is the nature of an adequate basis for such judgments. Can there, in fact, be such a basis? It is important in any ethical critique of this nature to distinguish the points of actual agreement and disagreement between the various methodologies. In this connection, it is sometimes observed that sociologists and psychiatrists are often rather critical of the theistic structures as a basis for ethical disapproval of suicide. The critique is often that this structure is far too inclusive and authoritative a judge of the suicide phenomenon. It is often seen as an "exterior" force or power that is indiscriminately impressed upon various kinds of conditions. Yet it is important to make dear that both sociology and psychiatry have developed somewhat parallel patterns of thought in confronting suicide. In sociology the power and value determinations of the community occupy a role similar in kind and degree to that of theism in theology. The community becomes the orientating and interpreting center from which both implicit and explicit value judgments are formulated. Similarly, the concept of the self occupies a central position in psychiatric methods. To be certain, there are a variety of constructive images of the self. However, in most 18

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instances the image or pattern is itself a crucial point for developing any ethieal judgments. The total preventive outlook of sociology and psychiatry toward suicide involves a duster of value judgments and assumptions concerning the nature of life, the goals of individuals, and the good of the eommunity. Thus it is important to recognize that, while soeiology and psychiatry may not, indeed, share the methods and judgments of either philosophy or theology, they have a series of parallel struetures with analogous relationships. The erueial issue this fact raises for further ethieal discourse is that the disciplines must develop patterns of thinking and expression that rely upon this implicit parallelism and the analogies it embodies. This, then, replaees illusory elaims of objeefive judgment formulated in opposition to the work of another discipline. There is a general reluetanee within sociology and psyehiatry as well as theology to discover instanees in which suieide might be approved in terms of ethical discourse. It does seem that Bonhoeffer's qualifying analysis is a bold attempt to accomplish this. Unlike the classical systems of psyehiatry, Kelly's work adopts a perspective that elearly embodies a neutrality with respeet to the ethical dimension of the problem. There are instances in whieh it will not be the appropriate human response, and there are others in which it is the only response of value. This offers one new line of development within psyehiatry, while that of Bonhoeffer presents a new pattern within the theological context. Bonhoeffer's proposal is not without eertain intrinsic problems. His qualifying structure is based upon limited human knowledge, and thus it is exceedingly uncertain as to whether it can, in fact, support the election of suicide. Basically it would seem to constitute a continuing opposition to this general postulate that suieide is not allowable beeause it may well eontradiet or destroy the goal of human life. It is significant to note the almost total absence within the various disciplines of any eonsideration for the collective dimension of suicide. To be certain, Thielieke's proposal is laden with problems of which a substantial mode of measuring and validating its analysis is a major item. But it does raise the issue and attempt to point to the reality of a crucial ethical dilemma. The primary issue in this respect is whether a populace is, in fact, eleeting suicide by ehoosing a particular course of action. If this is the ease, then attention must be directed to the ethieal basis and justification of this decision. Suicide Ethics

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Returning to the problem of the individual suicide, some suggestions ean be offered toward a revised perspeetive. These ean be seen as part of an operational pattern or moral exercise that attempts to provide some guidelines that go beyond the comfortable medians pertaining in much of the literature. There is a sense in whieh it is difficult to improve upon David Hume's essay. Certainly he provided effeetive counters to the soeial good and selfhood proscriptions as they are usually formulated. His work provided a degree of ethical flexibility that permits intensive eonsideration of individual eases and their eireumstanees. It is with respeet to Hume's initial argument that the greatest diffieulty is encountered. It rests upon the assumption that suicide involves no harm and is therefore not an infringement upon God. The erueial issue is elearly the definition of harm. The major problem with Hume's definition is that it fails to allow for the possibility that, in faet, the suicide aet could result in harm either to others or to the self. Without this qualifieation, the argument is eonsiderably weakened. Of eourse, this qualification would then necessitate a considerably more eireumseribed view of suicide than that of Hume's general approval. Any ethical refleetion on the question of suicide must, in the first plaee, be so structured as to take account of individuals. This is the major defect of all eode ethics and categorical judgments, whether they be negative or affirmative. The deeision has been made in advanee in the categorical methodologies irrespective of the individual involved. But suicide is an intensely personal matter as well as one with soeial and moral dimensions. The strueture of the self has an intimate bearing upon the suieide deeision, and this must be evaluated in ethical reflection. Secondly, the ethical examination of snieide will somehow attempt to aseertain what, if anything, was violated in the suieide aet. This issue would seem to provide pertinent material for any prohibition or approval. Presumably a violation would imply that the aet is not a suitable mode of expression. Thirdly, it would be desirable that ethieal refleetion maintain a flexibility to handle contingent circumstances. The first and second exercises demand this eondition, but the pattern has much to commend itself in addition to these. A degree of flexibility in ethieal reflection permits one to approach intently the many-sidedness of any moral dilemma. This does not mean that no guidelines or convictions are 2o

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brought to bear upon the situation. But it does imply the consistent application of clarity in making distinctions and a willingness to struggle with intricate and interdependent factors before making a judgment. It suggests that a case-centered ethics is the most relevant form of moral discourse. At the same time, in the fourth instance, an ethical consideration of suicide or a suicide decision should approach the issues in terms of the responsible self. That is, adequate attention will be given to the nature of the individual's patterns of responsibility. What are these and how are they best exercised? The presence of families or the dependence of others upon the life of the self vastly influences the morality of the suicide decision. Another factor is the relatedness of the self to its creator. Among the implicit assumptions often involved in ethical discussions of suicide are a preference for life over death and the so-called greater good argument. That is, it is often assumed that: a) life is a greater good than death; b) the greater good is preferable; c) therefore, life ought always to be preferred. The problem with this kind of discourse, as with all code ethics, is that premises a) and b) cannot be universally validated and thus the proscriptions may be useless and irrelevant or perhaps "immoral," within certain situations. At the same time, it is relatively easy to find cases in which the major premise ("life is a greater good than death") is denied by the greater good argument! This is where code ethics turns upon itself, destroying the total fabric of its discourse. In the suicide context, code ethics has often functioned not only to justify but to encourage or demand suicide for the greater good. Nations often employ this argument. But of course the definition of the greater good is usually assumed as a universal and then applied indiscriminately to all situations. It is exceedingly doubtful if this kind of argument functions to protect or preserve the sanctity of the self. Moreover, this kind of discourse fails to consider the critical question for suicide ethics of the property rights of the self. Is life a property right of the self? If so, to what extent is there license to suspend this right? Arguments for the greater good of the self or society assume that the greater good is always and unequivocally known to the one who makes the judgment. This is, to say the least, a dangerous if not simply absurd assumption. Apart from the context of specific cases or situations, it is virtually useless to seek a universal answer to hypothetiSuicide Ethics

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eal moral dilemmas. Decisions derived from hypothetical cases and then applied to actual situations fail to consider the self, the society, or the specific factors of the situation. The rigidity of code ethics always tells far more about the pathology of its advocates than it does about ethical reasoning for decision-making. Case-centered situation ethics

Religious bodies have not been noted for a willingness to re-examine their common proscriptions about suicide. While this does not offer much encouragement for the future debate, one potential source of change is to be found in the so-called new morality or situation ethics, largely a product of Anglican ethieists like Joseph Fletcher, James Pike, and John Robinson. The situationalist stance is a case-centered method of ethical discourse, and as I have already suggested, it is the most applicable and discriminating form of reasoning for confronting moral dilemmas. The situational approach rests upon general principles, none of which is regarded as universal law and all of which may be supplanted by the circumstances of a particular situation. The general basis for such discourse was formulated by Paul Tillieh when he wrote that "The moral imperative is the command to become what one potentially is, a person, within a community of persons. ''2s In the context of suicide ethics, a situational stance therefore affirms that in general it is imperative to decide for that which respects the sanctity of the self. While it is difficult to devise cases (and the situationalist does not live by such a proscriptive casuistry) where this affirmation would involve suicide, the situationalist is committed to leaving the question an open one-open to the empirical data and circumstances of the individual situation. What lies behind this stance and why is it relevant to the suicide dilemma? Basically, situation ethics is the attempt to deal pragmatically with persons involved in moral dilemmas as response to the inadequacies, errors, and breakdown of code ethics. It is the search for a better, more sensitive way of decision-making in the situation. Thus it is neither proscriptive, prohibitive, nor affirmative apart from individual eases; and most eases differ. As Bishop Pike has said, "Situation ethics is special ethics. Not special in the sense that there are abiding principles for the various categories of conduct. Special in the sense that situation 2z

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ethics takes account of the particular situation, the uniqueness of each human relationship, the distinctiveness of each person. ''~9 Case-centered ethics attempts to do what code ethics can never accomplish: namely, to answer why is this right or wrong or most prudential in terms of the intrinsic realities of the situation. It is, therefore, not only an alternative to the proscriptive, often prejudicial, and always indiscriminate applications of code ethics, but an attempt to take seriously the empirical world and the data of personal relationships as crucial to moral decisions. As Bishop Robinson suggested in Christian Morals Today, the old, proscriptive, nonempirieally based world view is simply no longer tenable, if in fact it ever was. It fails to take seriously the nature of persons and it ignores the realities of nature and society. Thus there is a degree of openness, tentativeness, or relativeness in ease-centered ethics. It is simply an attempt to recognize the unquestionable reality that truth finds different expressions in different ages. And thus Robinson has suggested that "there is no such thing as a Christian ethic. The raw material of an ethic is provided by the ethos of a society or a century or a group. Times change and even Christians change with them. ''8~ Having turned from the attempts of code ethics to absolutize the relative and having become attentive to the personal and the empirical, one must then ask what is case-centered or situation ethics about? W h a t does it seek or why is there any necessity for moral discourse if its assumptions are accepted? Robinson, Pike, Fletcher, and others have suggested that the sustaining principle of a ease-centered or situation ethics is the intrinsic good of love. Robinson is unequivocal about this: "In Christian ethics the only pure statement is the command to love: every other injunction depends on it and is an explication or application of it. ''Sx Fleteher's proposal has become the key statement of this position: "Only one thing is intrinsically good; namely, love: nothing else at all. ''82 Moreover, situation ethics holds that what love means can only be decided in the ease, not antecedently or indiscriminately. This is not a pleading for excusable evil; rather, whatever is the most loving action in the situation becomes the good. ~Vith love as its guide and goal in action, situation ethics says: It all depends on the circumstances of the ease itself. The ethical decision will be for the most loving action in the situation. Love is not a quantity or principle, but the active response of the self to the contingencies of particular situations. Suicide Ethics

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Fletcher presents for consideration the well-known suicide example involving a captured soldier whose life threatens the lives of others and a case involving terminal illness. In Moral Responsibility he has explored the implications in terms of the related problems of euthanasia and anti-dysthanasia. 34 Pike presents an example involving terminal illness in his case book, Y o u and the N e w Morality. 85 All these cases are presented to underline the desirability of decision-making in the context of specific cases, wherein the most loving response may vary from situation to situation. T h e sanctity of the self can be affirmed and protected only in this manner, for we have seen that the gyrations of code ethics and legalisms can be indiscriminately employed to advocate or condemn suicide. Ultimately, if decision-making is to avoid the easy and meaningless proscriptions of code ethics out of preference for persons, it will take place in the situation. T h e degree to which this method is utilized in suicide ethics will continue to be an index to the usefulness and meaningfulness of the moral discourse. W i t h o u t these qualities its function is quite unnecessary and absurd.

REFERENCES i. Kobler, Arthur, and Stotland, Ezra, The End of Hope. New York, The Free Press-Macmillan, i964. 2. See especially Klopfer, Bruno, "Suicide, The Jungian Point of View." In Faberow, Norman L., and Shneidman, Edwin S., eds., The Cry For Help. New York, McGraw-Hill, I96I. 3. See especially Sullivan, Harry Stack, The Interpersonal Theory of Psychiatry. New York, Norton, i953. 4. DeRosis, Louis, "Suicide: The Horney Point of View." In Faberow and Shneidman, op. cir. 5- Kelly, G. A., "Suicide: The Personal Construct Point of View." In Faberow and Shneidman, op. cit. 6. Ibid., p, 259.

7. Hillman, James, Suicide and the Soul. New York, Harper and Row, i964, p. 2 39

8. Ibid., p. 51.

9. Williams, Glanville, The Sanctity of Life. New York, Knopf, I957. io. Ibid., p. z48.

i I. St. John-Stevas, Norman, Lile , Death, and the Law. Bloomington, Ind., Indiana University Press, I96I, p. z58. xz. Cahn, Edmond, The Moral Decision, Bloomington, Ind., Indiana University Press, I955, p. z39. I3. Ibid., p. 24o. x4. Ibid.

I5. Sprott, S. E., The English Debate on Suicide. LaSalle, Ill., Open Court Publishing Company, I96I, p. Iz9. "4

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I6. Landsberg, Paul Louis, The Moral Problem of Suicide. New York, Philosophical Library, I9H, p. 80. x7. Ibid., pp. 83-84. 18. Sidwick, Henry, The Methods of Ethics. Chicago, University of Chicago Press, i9o7, pp. 327, 33 I, 357. x9. Vivas, Eliseo, The Moral Life and the Ethical Life. Chicago, University of Chicago Press, I95o, p. 343. 20. Westermarck, Edward, Christianity and Morals. New York, Macmillan, i939, p. 254. zx. Healy, Edwin F., Medical Ethics. Chicago, Loyola University Press, i956, p. IO.

zz. Davis, Henry, Moral and Pastoral Theology. Vol. II, London, Sheed and Ward, 1959, pp. I42-I44. z 3. O'Donnell, Thomas, Morals in Medicine. Westminster, Md., Newman Press, i96o, p. 60. 24. Bonhoeffer, Dietrich, Ethics. New York, Macmillan, i955, p. i24. 25. Ibid., p. 126. 26. Thielicke, Helmut, Nihilism. New York, Harper and Row, 196I, pp. 158-16I. 27. Ibid., p. 47. 28. Tillich, Paul, Morality and Beyond. New York, Harper and Row, 1963, p. 19. z9. Pike, James A., You and the N e w Morality. New York, Harper and Row, I967, p. I29.

30. Robinson, John A. T., Christian Morals Today. Philadelphia, Westminster Press, 1964, p. 14. 3 I. Ibid., p. I6. 3"" Fletcher, Joseph, Situation Ethics. Philadelphia, Westminster Press, 1966, pp. 56 IT. 33. Ibid., pp. 66 and i66. 34. Fletcher, Joseph, Moral Responsibility. Philadelphia, Westminster Press, I967, chapter 9. 35. Pike, You and the N e w Morality. op. cit.

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Suicide ethics in cross-disciplinary perspective.

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