Maybe someone else already commented about this, but what about the parents? In their 80's and caretakers of a daughter with epilepsy, who is mentally and physically impaired as a result of a stroke and who is a paranoid schizophrenic? How long can they be expected to provide care? What happens when they too need care? Surely the ailing sister is aware of these things. Surely the the sibling asking the question is aware of these things. And surely the parents are aware. Think through the implications from each perspective. Paul, in an earlier comment, thought it was the questioning sibling who needed attention. That is certainly accurate. But there is way more to it than the emotional pain and stress caused by the single ethical issue of assisting in a suicide. I'm not going to spell it out. The only thing I know is that I don't know the answer. I wonder if there is an ethical answer and I wonder about the emotional, psychological, and economic consequences regardless of the path chosen. There doesn't seem to be an outcome devoid of pain, suffering, and tragedy for everyone involved.
6
It really scares me that this sibling is on a rant on how awful her sisters life is, knowing full well that her conditions are chronic and that with anything chronic there can be ups and downs.....She is not the primary care giver, why is she bent on catastrophizing her poor sisters life? Such alarmist are a danger to society, they remind me of an actuary from an Insurance Company trying to calculate how little they should pay out for someones miserable life!!
Is there a meaningful difference between assisted suicide and letting someone die by withholding life-extending care? I would say that there is, though there is a lot of gray area at the boundary.
DNRs are well established vehicles of instructing caretakers to withhold potential life-extending care. The "plug" is pulled on patients who cannot live without the help of a machine. Let's ignore the homocide vs. assisted suicide discretion here and consider these to be passive means of ending a life.
On the other side there are active versions of assisted suicide, which might also be called consented homocide (might apply to the passive versions as well).
I would argue that the passive ones might be acceptable, while the active ones not so much. There is a lot of gray area in between, I don't deny it. Does the sister's sibling have an opportunity for a passive end?
DNRs are well established vehicles of instructing caretakers to withhold potential life-extending care. The "plug" is pulled on patients who cannot live without the help of a machine. Let's ignore the homocide vs. assisted suicide discretion here and consider these to be passive means of ending a life.
On the other side there are active versions of assisted suicide, which might also be called consented homocide (might apply to the passive versions as well).
I would argue that the passive ones might be acceptable, while the active ones not so much. There is a lot of gray area in between, I don't deny it. Does the sister's sibling have an opportunity for a passive end?
Once it has been decided that assisted suicide is a morally acceptable, why is there then a moral question as to who gets to make that decision for themselves. States that allow assisted suicide limit it to people who have terminal illness and are suffering. This is probably because that is the only way the law could pass.
But we're talking about ethics and morals here, not the law. If it's okay for a person who is dying and suffering physically to facilitate the ending of their life, why not a person who is suffering physically and/or emotionally with no short term end in sight? if a person no longer wants to live, why should we force them to.
I agree there should be some standards and limitations, but if assisted suicide is okay, then it's okay. My prediction is that it will become legal in more and more states and eventually we will come to recognize it as a moral and kind alternative for far more people.
But we're talking about ethics and morals here, not the law. If it's okay for a person who is dying and suffering physically to facilitate the ending of their life, why not a person who is suffering physically and/or emotionally with no short term end in sight? if a person no longer wants to live, why should we force them to.
I agree there should be some standards and limitations, but if assisted suicide is okay, then it's okay. My prediction is that it will become legal in more and more states and eventually we will come to recognize it as a moral and kind alternative for far more people.
12
There is no ethical dilemma in case 1. The sister is not terminally ill, is not in intractable physical pain and, as noted, has managed to not die despite "dozens" of suicide gestures. The one thing she is being successful at is inflicting severe emotional pain and stress on her sibling. It is the 'well' sibling here who needs attention.
8
In that case, Paul, I must reply to you, as I did to the Ethicist him/herself:
"IMO, "…multiple failed suicide attempts ... might give you reason to think your sister isn’t committed to carrying it through…” is a highly un-empathic, uninformed, and dangerous statement."
"IMO, "…multiple failed suicide attempts ... might give you reason to think your sister isn’t committed to carrying it through…” is a highly un-empathic, uninformed, and dangerous statement."
13
As a former caregiver for 8 years I experienced a situation when my aged mother-in-law lingered on with oxygen, catheter, 80 percent sight loss, no hearing, and the inability to leave her bed. my spouse and I realized she was afraid to die. is this quality of life? would anyone rationally trade places with her and wish for themselves such an end? we don't need more armchair moralists. we need ethical and caring answers.
5
Re: the second letter.
I run a Jewish school. I require my teachers to log all extra hours they work: lesson planning, emails, meetings. To do otherwise violates Federal, State, and Biblical law (both Leviticus and Deuteronomy). The director should thank the writer for reminding the organization of its legal -- and religious -- responsibility.
I run a Jewish school. I require my teachers to log all extra hours they work: lesson planning, emails, meetings. To do otherwise violates Federal, State, and Biblical law (both Leviticus and Deuteronomy). The director should thank the writer for reminding the organization of its legal -- and religious -- responsibility.
12
As a published author, I am frequently asked to work for free as a "favor."
"Could you just read this and make sure it's ok?"
"I wrote a business statement and need to know it sounds professional."
"Does this first chapter hook the reader?"
etc etc etc
I know a professional photographer who gets similar requests all the time.
People need to understand that 95% of artists struggle financially. Despite her "religious" affiliation, Gina's boss behaved in a most unethical fashion because she no doubt knew Gina would feel if she turned down the request, she might lose a critical source of income. In this case, the manager behaved in an unethical fashion. I'd call it silent blackmail.
"Could you just read this and make sure it's ok?"
"I wrote a business statement and need to know it sounds professional."
"Does this first chapter hook the reader?"
etc etc etc
I know a professional photographer who gets similar requests all the time.
People need to understand that 95% of artists struggle financially. Despite her "religious" affiliation, Gina's boss behaved in a most unethical fashion because she no doubt knew Gina would feel if she turned down the request, she might lose a critical source of income. In this case, the manager behaved in an unethical fashion. I'd call it silent blackmail.
20
Yes, this happens to writers all the time. I just smile and either tell them I'm completely booked and to find an editor, or give them my rate card. Shuts them up very quickly.
9
As the pastor of a church, I run into the problem all the time of "when do we pay?" and "when is help volunteer?" It's somewhat the opposite of the writer's issue, but when a congregant has a business and we want that business's services, we offer to pay. If the person says, "No, I will donate the service," that is fine. But I don't want the person to feel that we are taking advantage of him/her. In the specific case of the writer: I would never think of asking a nonmember employee to volunteer her/his services.
17
Regarding letter number two, it is most likely illegal for the employer to ask an employee for work off the books as a "favor." It is certainly unethical to do so. A person simply cannot be both employee and volunteer for the same organization. Even when the intent of all involved is pure as driven snow, the potential for abuse is simply too great. The only proper solution is a bright, clear line where everyone's expectations are unambiguous. All of an employee's work is on the books and paid. Opportunities for advancement are then based on who does good work, rather than who does the most for free. This kind of clarity is also the best way to completely eliminate an "unhelpful" work environment, as no one is left guessing just how many unremunerated favors are required to be considered "helpful."
13
The "free help" situation gets its resonance because it's a mash-up of different, inconsistent ways we have of relating to each other. Using anthropologist Alan Fiske's Relational Models, the situation engages community sharing, where people are expected to pitch in for the group as a matter of course (such as a communal dinner) without giving it a second thought or expecting anything else in return (except more community sharing). But it also engages authority ranking, where the people in authority should be honored and obeyed, but should not abuse their authority (which the writer thought was going on here.) AND it also engages market pricing, where people make agreements for proportional exchanges (as in wages for work, or giving free service to "get ahead.") Where we come out depends in part on which model set our thinking is in. The problem is in part a conflict of different people using different relational models, or even one person swinging wildly from one model to another. The request seems to me to be an abuse of authority and a disproportionate, unfair exchange, but I might react less critically if I knew more about how the organization operates communally with its members.
Jon in NYC
Jon in NYC
4
I wonder if "Janet" has found a new love and asked her friend for secrecy and care for "Dave" because she doesn't want to deal with his illness and need for care herself. When a friend asks another friend to keep a secret it's often because they know their motivations are questionable and unethical. No one should ever agree to a friend's request to keep a secret and do a favor until they know what it entails. That's the best way to avoid the ethical dilemma LW3 was facing.
3
I'm not a big one for retrospective oaths. It's not clear to me if Janet sought confidentiality before or after she shared the information. In my experience, it is more common that friends divulge stuff before adding, "and don't tell Dave." I would not be hesitant, in that situation, to simply say, "I'll think about it," while making it clear that I won't willy-nilly, just pick up the phone and broadcast the secret. But I think it is important to retain that option when confronted with post-revelation conditions.
If the request for privacy is made before the information is given, it is somewhat different, but I still think it's important to say, "probably, depends on what you're going to say." Most people who have decided to share information with a friend, have made that decision regardless of the response. She is bubbling over with desire to tell you what's going on. Nothing is going to stop her from sharing the information, and it leaves you with the option to, later on, let her know that you are not comfortable holding on to what you were told. You can then tell her to tell Dave herself, unless she prefers for the friend to tell him, and frees her up to be an honest friend to him.
If the request for privacy is made before the information is given, it is somewhat different, but I still think it's important to say, "probably, depends on what you're going to say." Most people who have decided to share information with a friend, have made that decision regardless of the response. She is bubbling over with desire to tell you what's going on. Nothing is going to stop her from sharing the information, and it leaves you with the option to, later on, let her know that you are not comfortable holding on to what you were told. You can then tell her to tell Dave herself, unless she prefers for the friend to tell him, and frees her up to be an honest friend to him.
3
Despite her serious conditions, most people, whether they are physically or mentally ill, have variations in their symptoms. I would not assume that because her conditions pertain to her mental status, that she is never lucid or able to think for herself. I think the writer should tell her sister she won't talk with her based on a panicked call, but will schedule a time when they can get together, as equals, perhaps outside the home over coffee or a meal. Ask her then what she really wants..
I would also add the writer and the disabled sister have the same parents who are in their 80s. So the other discussion, worth having, is what will life be like when the parents are gone. These daily calls may be a sideways attempt on the part of both sisters, regarding what will life be like down the road.
I would also add the writer and the disabled sister have the same parents who are in their 80s. So the other discussion, worth having, is what will life be like when the parents are gone. These daily calls may be a sideways attempt on the part of both sisters, regarding what will life be like down the road.
5
For letter #2, if "Gina" is an hourly employee, the school is violating federal wage and labor laws and must pay the employee for hours worked. If the employee is salaried then she and her employer are free to work out arrangements for her working on other projects. Non-profits should be very careful on the wage issues because penalties are high.
4
As a graphic designer I've been approached many times to work for free. After all, it's "fun" to be an artist, right? Not really work at all drawing those pretty pictures. I've realized late in life that being asked to work for free by someone in a position of power over you is no different, really, than being asked to serve time on the casting couch in order to get that part in the film.
7
LW 1: It is a tough call since your sister is over 50. But given her apparently incurable conditions, and the fact that she is obviously miserable, I think the ethical thing to do would be to allow her to commit suicide and die with dignity. Help her to do so the extent you can without putting yourself in legal jeopardy.
2
In 21st-century America, most religious institutions are in desperate shape. A lot of their leadership and adherents are systematically denying that reality, but others are not.
When a leader asks for a donation (of cash or services) that's not wrong. In America most religious institutions are voluntary: donations are their key to survival.
When somebody donates their services that's not wrong either.
What is wrong, then? Simply put, the supervisor's statement that donating their labor helps people "get ahead" is a lie. The supervisor can't deliver on that, either in its worldly or its "pie-in-the-sky by-and-by" aspect.
It also corrupts the spirit of generosity upon which the institution depends.
When a leader asks for a donation (of cash or services) that's not wrong. In America most religious institutions are voluntary: donations are their key to survival.
When somebody donates their services that's not wrong either.
What is wrong, then? Simply put, the supervisor's statement that donating their labor helps people "get ahead" is a lie. The supervisor can't deliver on that, either in its worldly or its "pie-in-the-sky by-and-by" aspect.
It also corrupts the spirit of generosity upon which the institution depends.
6
The first letter is terribly sad, and I will only repeat what some others have already said: the sister likely needs treatment for depression, if she isn't already getting that. I'm no expert, but dozens of suicide attempts may be more indicative of a need for help than a real desire to end her life.
"Janet" in the third letter wanted someone to do her dirty work and spill the beans to "Dave." That's why she told multiple people that she'd moved on to someone new. Now she gets to be self-righteously angry at the blabber, which will ease some of her guilt over jilting her sick partner. Ugh. Be a good friend to Dave and say good riddance to Janet. He's better off without her.
"Janet" in the third letter wanted someone to do her dirty work and spill the beans to "Dave." That's why she told multiple people that she'd moved on to someone new. Now she gets to be self-righteously angry at the blabber, which will ease some of her guilt over jilting her sick partner. Ugh. Be a good friend to Dave and say good riddance to Janet. He's better off without her.
6
Please don't ask those you know to keep things private. Please don't ever agree to keep things private either before or after hearing them. Never have I experienced such agreements as anything more than neurotic manipulations on the parts of almost everyone involved. Someone will be hurt of offended when the secret comes out (and it will). And the secret-keeper will feel resentful for being use, feeling unappreciated, and guilty and lacking in integrity. These things go better when a therapist (who is sworn to secrecy) is involved, so suggest this.
3
Keep in mind the authorities look very closely whether someone has abetted in the suicide of a loved one. A notice in the NYT might be used as evidence against you.
4
The first writer writer says that the sister has the best social workers, doctors and therapists, but that none of them "can give her a fulfilling life." It is not the responsibility -- nor is it within the realm of possibility -- for anyone to make another person's life fulfilling. That must come from within. Those service providers have an ethical duty to see that the patient or client is adequately medicated, her psychiatric and other health issues monitored, and her emotional problems addressed. But they cannot change the circumstances of her life. The sibling who takes those desperate phone calls is right to empathize, to offer a sympathetic ear, and to do what is within her or his ability to make the sister's life easier or more joyful. But one cannot force another person to be happy. All one can do for the despairing is offer love, friendship, and time.
It is my experience that those who are serious about suicide do not generally make several unsuccessful attempts, so perhaps this is more a cry for help than a true wish. As much as I hurt for the sister, I feel that it's wrong of her to put her sibling in this difficult position. It's not fair. Information on self-euthanasia is available online. If a person who thinks she wants that is too conflicted to act, isn't it unethical for her to ask someone who loves her to decide for her? Because that is what helping her would amount to: giving permission.
It's a terrible pickle, though. I am so sorry for both of them.
It is my experience that those who are serious about suicide do not generally make several unsuccessful attempts, so perhaps this is more a cry for help than a true wish. As much as I hurt for the sister, I feel that it's wrong of her to put her sibling in this difficult position. It's not fair. Information on self-euthanasia is available online. If a person who thinks she wants that is too conflicted to act, isn't it unethical for her to ask someone who loves her to decide for her? Because that is what helping her would amount to: giving permission.
It's a terrible pickle, though. I am so sorry for both of them.
4
This advice always sounds as though it's coming from such a privileged, sheltered, even childish place. What I miss: well-written papers that aren't by and for rich kids. Remember them? Boy, they were terrific.
1
Re: Keeping the secret:
I have had enough of people saying "Promise you'll never tell." Until you have been told the secret yourself, you cannot begin to decide if this is a promise it is right to keep. If the original secret-bearer doesn't want her/his secret to get out, the solution is simple: keep their mouth shut. As Benjamin Franklin warned, "Three may keep a secret... if two of them are dead."
I have had enough of people saying "Promise you'll never tell." Until you have been told the secret yourself, you cannot begin to decide if this is a promise it is right to keep. If the original secret-bearer doesn't want her/his secret to get out, the solution is simple: keep their mouth shut. As Benjamin Franklin warned, "Three may keep a secret... if two of them are dead."
5
1--Stop taking the nightly calls because taking those calls is in no way helping your sister. You cannot be her coping mechanism. The calls are not making her happy; her happiness, despite her conditions, must come from within. Every call you take blocks that process from happening within her. Don't cut her off, but limit the calls you'll take to 1 or maybe 2 week.
2--The boss feels guilty. It's absolutely not wrong to express your opinion to a coworker. The boss' problem is not your fault.
3--If asked to hear something in confidence, refuse.
2--The boss feels guilty. It's absolutely not wrong to express your opinion to a coworker. The boss' problem is not your fault.
3--If asked to hear something in confidence, refuse.
5
All murder is sin. (That includes "self murder".)
Almighty God, and Him alone, has the right to end a human life. (He has granted to the State the right to punish by Capital Punishment [putting certain convicted criminals to death]).
In protecting society, policemen and soldiers may (within the will of God [when totally necessary]) restrain evil by the use of deadly force. Self defense (without recourse) may (at times) fall in this category.
Gods says, Thou shalt not kill.
Almighty God, and Him alone, has the right to end a human life. (He has granted to the State the right to punish by Capital Punishment [putting certain convicted criminals to death]).
In protecting society, policemen and soldiers may (within the will of God [when totally necessary]) restrain evil by the use of deadly force. Self defense (without recourse) may (at times) fall in this category.
Gods says, Thou shalt not kill.
1
And all that is awesome, if a person buys into your God. My God doesn't have those rules, and I don't see why I should have to live by rules made for *you* by *your* God.
If you don't want an assisted suicide, don't have one, and don't help. But you've got no business attempting to prevent anyone else who wants one to have one.
If you don't want an assisted suicide, don't have one, and don't help. But you've got no business attempting to prevent anyone else who wants one to have one.
8
A careful reading of the first letter reveals that the ill sibling is not in physical pain, not in the throes of terminal disease and wants to die because she feels "isolated and miserable". Multiple failed attempts suggests a reaching out for attention and sympathy, but does not come close to reasonable cause for suicide. When this is combined with diagnoses of paranoid schizophrenia and mental impairment it is clear that while helping this poor woman end her life might provide a measure of relief for the rest of the family, there is no basis to justify ending this life under any legal or ethical paradigm. If being lonely and miserable were cause for suicide there would be few of us around to bury the rest.
1
Emotional pain can hurt as much as the pain of a terminal malignancy, so the person begs final relief.
Psychotic features most often manifest themselves during an active episode. Person usually doesn’t live in a persistently psychotic state, if under treatment, except for some intractable cases. Most florid symptoms/signs remit [usually with antipsychotic meds/supportive psychotherapy]. Schizophrenia can be in remission, w/o psychotic features. Still, it is a chronic disorder, with potential for relapse.
A detailed Capacity Evaluation ought be performed by the Psychiatrist, apart from the Mental Status Exam. It includes specific criteria. [“Capacity” is the medical term for “Competence,” the legal equivalent.] “Psychotic” by itself does not equal “lacking Capacity” to make treatment decisions. If capacity preserved, specific treatment choices remain the person’s own, w/o proxy.
Sib. does seem profoundly depressed, but has major reasons to be so.
Agree: UPDATE Psychiatric and Risk Assessments, dxs, and med/treatment re-eval., with particular attention to major DEPRESSIVE symptoms. Multiple etiologies possible — including certain personality clusters. Then provide the treatment that fits.
Agree: NO ASSIST: 1] legal issues; 2] other modalities for relief have not yet been explored.
IMO, "…multiple failed suicide attempts ... might give you reason to think your sister isn’t committed to carrying it through…” is a highly un-empathic, uninformed, and dangerous statement.
Psychotic features most often manifest themselves during an active episode. Person usually doesn’t live in a persistently psychotic state, if under treatment, except for some intractable cases. Most florid symptoms/signs remit [usually with antipsychotic meds/supportive psychotherapy]. Schizophrenia can be in remission, w/o psychotic features. Still, it is a chronic disorder, with potential for relapse.
A detailed Capacity Evaluation ought be performed by the Psychiatrist, apart from the Mental Status Exam. It includes specific criteria. [“Capacity” is the medical term for “Competence,” the legal equivalent.] “Psychotic” by itself does not equal “lacking Capacity” to make treatment decisions. If capacity preserved, specific treatment choices remain the person’s own, w/o proxy.
Sib. does seem profoundly depressed, but has major reasons to be so.
Agree: UPDATE Psychiatric and Risk Assessments, dxs, and med/treatment re-eval., with particular attention to major DEPRESSIVE symptoms. Multiple etiologies possible — including certain personality clusters. Then provide the treatment that fits.
Agree: NO ASSIST: 1] legal issues; 2] other modalities for relief have not yet been explored.
IMO, "…multiple failed suicide attempts ... might give you reason to think your sister isn’t committed to carrying it through…” is a highly un-empathic, uninformed, and dangerous statement.
5
Work for free and you'll get another star in your crown in heaven? It's one of the worst kinds of emotional blackmail, especially if the worker has people who depend upon her for support.
Despite its orientation (religious) it's functioning as a business, and should be run like a business - ethical performance and paying its staff appropriately.
Despite its orientation (religious) it's functioning as a business, and should be run like a business - ethical performance and paying its staff appropriately.
6
As a suicide hotline responder, I am dismayed by your remarking to the person troubled about her suicidal sister that "Her multiple failed suicide attempts, moreover, might give you reason to think your sister isn’t committed to carrying it through."
This propagates a dangerous and discredited myth, that has been comprehensibly debunked by multiple respected scientists, notably Thomas Joiner in his book "Myths About Suicide" (Harvard University Press, 2010).
In fact, multiple prior attempts are an extremely strong indicator that the person is persistently wearing away at their survival instinct, because they are determined to end their life and will probably do so eventually unless they get some appropriate help. The more history someone has of suicidal and para-suicidal behaviour, the higher the probability that they will end up dying by suicide.
This propagates a dangerous and discredited myth, that has been comprehensibly debunked by multiple respected scientists, notably Thomas Joiner in his book "Myths About Suicide" (Harvard University Press, 2010).
In fact, multiple prior attempts are an extremely strong indicator that the person is persistently wearing away at their survival instinct, because they are determined to end their life and will probably do so eventually unless they get some appropriate help. The more history someone has of suicidal and para-suicidal behaviour, the higher the probability that they will end up dying by suicide.
8
One - I feel for the LW. it is overwhelming watching a loved one suffer so, but he cannot assist her in committing suicide. Assisting someone to commit suicide is illegal in all states and with her mental impairment how can he be sure that is what she truly wants
Two- I see no ethical conundrum in the LW suggesting to Gina that she should be compensated. It may have been a politically unwise decision particularly with the director’s response. Employees going above and beyond should be desired not required. With the exploitative nature of today’s workplace, quid pro quo is the status quo, unfortunately all too often it is a win-lose situation with management profiting from their employees’ sacrifices.
Three - the LW. has an ethical obligation to keep her promise to Janet. Consider it a lesson learned, and next time be weary, very weary, when someone tries to swear her to secrecy. As to Dave, did he not wonder about Janet's absence at a time when he needed her?
Two- I see no ethical conundrum in the LW suggesting to Gina that she should be compensated. It may have been a politically unwise decision particularly with the director’s response. Employees going above and beyond should be desired not required. With the exploitative nature of today’s workplace, quid pro quo is the status quo, unfortunately all too often it is a win-lose situation with management profiting from their employees’ sacrifices.
Three - the LW. has an ethical obligation to keep her promise to Janet. Consider it a lesson learned, and next time be weary, very weary, when someone tries to swear her to secrecy. As to Dave, did he not wonder about Janet's absence at a time when he needed her?
It sounds like your sister cannot really judge for herself: that is the tragedy. She may say she wants to die, but she may not be clear on what death means, or even that death is permanent. If it were me, I would do this for a parent or sibling dying horribly of an incurable disease, if he or she were sane, able to judge. Otherwise, not. This situation sounds as though your sister cannot really judge. I also think you are not responsible for making her happy, just for being there--listening when she asks you to do so, and when you can bear listening to her.
http://www.thecriticalmom.blogspot.com
http://www.thecriticalmom.blogspot.com
I run a theatre festival in which I believe firmly that everyone should get paid (usually starting at $10 an hour, no benefits, and going up to $22 an hour, or even more if we're talking about a fee or honorarium for a set amount of work). I have a technical person whose duties have expanded. He also on the side does Web-site design. From time to time he has done design work at no charge in the hope that I will pay him later if I like his work, and in fact I have sent him occasional work at $25 an hour when my regular Web guy is out of action. I accepted his offer of free labor at face value (ie a way to get a leg up in the organization) but have now graduated to the principle that I'll pay for everything he does from now on. I'm still willing to accept free labor, in the form of a sample, on the understanding that the person doing so has the possibility of rising higher and getting paid from then on.
My father just died of cancer. Lived a long and full life, but to go out with such a wicked disease is just wrong (for anyone, that is); thankfully he only had a few months of dealing with it. Yet, I have some anger about it in general, but the gist of it is: in this country, this world, where we consider ourselves the alpha species, the Big Dogs, the Intelligent Ones, we still have no clue about approaching death in any way that promotes dignity and quality - not of life, but quality of death.
When Death is looking you in the eye, and Society demands you sit there and take it until you effectively drug yourself into a stupor so you quit eating, quit drinking, your organs begin to fail and you can then "die peacefully", well, that's just wrong. Whether for misguided religious beliefs or somewhat understandable murky legal areas, there still should be some bona fide way for a person to check out of life whenever the hell he or she desires to do so.
Especially someone who is in pain, in misery, and simply no longer wants to live. Why does society force people to buy the gun, make the noose, or otherwise stock up the opiates just so one can escape?
Shameful.
When Death is looking you in the eye, and Society demands you sit there and take it until you effectively drug yourself into a stupor so you quit eating, quit drinking, your organs begin to fail and you can then "die peacefully", well, that's just wrong. Whether for misguided religious beliefs or somewhat understandable murky legal areas, there still should be some bona fide way for a person to check out of life whenever the hell he or she desires to do so.
Especially someone who is in pain, in misery, and simply no longer wants to live. Why does society force people to buy the gun, make the noose, or otherwise stock up the opiates just so one can escape?
Shameful.
12
My heart goes out to the first letter writer. I also have a middle aged disabled sibling who lived at home with my mother until she developed Alzheimers. It is a difficult situation.
My answer is no, the letter writer should not held her disabled sibling commit suicide. Kwame Appiah has laid out the abstract ethical reasons against it, but there are other reasons as well.
First, it seems to me that both the letter writer and her sister are overwhelmed; the sister by her situation, and the letter writer by the nightly calls and by her family's needs. My family felt that way many times - but honestly, much of that came from ways my parents, with the best intentions, limited my brother's options. "I could never put him in a group home - that's too cruel!" "I could never send him to a day program - he might be abused!" "I could never put him on an anti-psychotic medication - I don't want him doped up!" How much of that is happening in the letter writer's family? Is this family genuinely out of options, or are they rejecting options offered by the MDs, social workers, and therapists out of hand?
On a more practical level, assisting a suicide is illegal in most states. In states where it is legal, only physicians, not family members, are legally permitted to assist. Depending on your state, you could be charged with manslaughter or other felony. One can only speculate what the trial, in the court and perhaps the media, would be like.
My answer is no, the letter writer should not held her disabled sibling commit suicide. Kwame Appiah has laid out the abstract ethical reasons against it, but there are other reasons as well.
First, it seems to me that both the letter writer and her sister are overwhelmed; the sister by her situation, and the letter writer by the nightly calls and by her family's needs. My family felt that way many times - but honestly, much of that came from ways my parents, with the best intentions, limited my brother's options. "I could never put him in a group home - that's too cruel!" "I could never send him to a day program - he might be abused!" "I could never put him on an anti-psychotic medication - I don't want him doped up!" How much of that is happening in the letter writer's family? Is this family genuinely out of options, or are they rejecting options offered by the MDs, social workers, and therapists out of hand?
On a more practical level, assisting a suicide is illegal in most states. In states where it is legal, only physicians, not family members, are legally permitted to assist. Depending on your state, you could be charged with manslaughter or other felony. One can only speculate what the trial, in the court and perhaps the media, would be like.
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You make good points. The LW does not make clear the attitudes of the parents and their willingness to use services. The LW says the LW's sister has received excellent care. But we really do not know if that is true; the most competent providers may not always "get it right" There more that can be done.
Also, what about the parents' role as caregivers? Are they the sister's power of attorney? Is she actually competent to make decisions about her care? Is she really looking for advice from the LW or is she looking more for a sympathetic ear? While the sister has rights, including to a good quality of life, we do not know if she is looking for real guidance on effecting suicide and what the effect would be if the LW provided that to her, even stopping short of directly assisting her. Would her sister feel pressured to utilize those means? Has she truly meant to die through her unsuccessful suicide attempts or is she, in part, demonstrating her truly tragic suffering, but not sure she really wants to die?
What of the parents? While the LW's first concern should be her sister, should the parents have a say, if they are her guardians? What happens if they find out if the LW gives the sister detailed information, whether or not the sister acts on it?
Many relatives are placed in such situations, I believ, with people who might not even be as ill. The LW may need to distance him/herself and not always take the calls. The LW's own stress could cloud his/her judgement.
Also, what about the parents' role as caregivers? Are they the sister's power of attorney? Is she actually competent to make decisions about her care? Is she really looking for advice from the LW or is she looking more for a sympathetic ear? While the sister has rights, including to a good quality of life, we do not know if she is looking for real guidance on effecting suicide and what the effect would be if the LW provided that to her, even stopping short of directly assisting her. Would her sister feel pressured to utilize those means? Has she truly meant to die through her unsuccessful suicide attempts or is she, in part, demonstrating her truly tragic suffering, but not sure she really wants to die?
What of the parents? While the LW's first concern should be her sister, should the parents have a say, if they are her guardians? What happens if they find out if the LW gives the sister detailed information, whether or not the sister acts on it?
Many relatives are placed in such situations, I believ, with people who might not even be as ill. The LW may need to distance him/herself and not always take the calls. The LW's own stress could cloud his/her judgement.
The writer should put a limit on the highly calls from her sister. Would be best for the latter to discuss the theme of suicide with one of the professionals treating her. Assisted murder is not a legal or ethical option.
The LW makes it clear that the parents are willing to use services. They are using the "very best doctors, social workers, and therapists."
Doing free work in the workplace is not how people get ahead--it's how they get taken advantage of. Also, it's wage theft.
I work part-time at a small non-profit and am strict about setting boundaries and only doing work I'm paid for. The result? My bosses are eager to pay me for more hours because they know that's the only way they'll get more work out of me. I've seen many colleagues donate those extra hours out of guilt and they do not get compensated for them in promotions or raises later.
I work part-time at a small non-profit and am strict about setting boundaries and only doing work I'm paid for. The result? My bosses are eager to pay me for more hours because they know that's the only way they'll get more work out of me. I've seen many colleagues donate those extra hours out of guilt and they do not get compensated for them in promotions or raises later.
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I have more of a question than an answer. The first letter broke my heart and this line stood out to me: "She calls me every night crying..." At what point is it callous to refuse these calls? It sounds to me as if the sister doesn't have much of a quality of life either. Life has obviously been very unfair to the sister who is ill. But is she being fair to a person who evidently cares about her when she calls her every single night? We cannot take the pain of others. While there is likely much that can be done to help the parents take care of the ailing sister, the sister who wrote is in a no-win situation. She feels compelled to have an answer about the worth of her sister's life because her sister has dumped it all in her lap. Perhaps she should steer her gently to a psychiatrist or other health professional and, while helping as much as she can manage, create some boundaries between her sister's life and her own?
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Wow. It's a good thing that you haven't yet experienced this sort of request from a seriously ill friend, sibling, or parent. Talk about callous! If I had these profound ailments and complications with no end in sight I would hope that those closest to me would try at least to understand how and why I'm feeling crazed and beyond desperate! I've been in the situation of being asked to facilitate a suicide in a state that allowed assisted suicide, and I agreed.
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@WandaFries You make such an excellent point. Each of us has a limited amount of time and energy. Each of us has obligations to fulfill - family, work, etc. Allowing a super-needy person to take all of your time and energy means that they have stolen from you and everyone else who looks to you for help and support. When I visualize the first letter, I see the LW as a balloon full of life, and the sibling sticks in a pin and drains it all away. If the LW doesn't set some boundaries, everyone will suffer - the LW, the sick sibling, the LW's other loved ones. There are people who care only about themselves, and their needs are all that count - the LW's sibling sounds like such a person. The LW might consider reporting the suicide threats to 9-1-1, and maybe the sibling needs a commitment to psychiatric facility to get professional help. My bottom line -- Don't help with the suicide - limit the phone calls, call for professional help - don't get sucked into something beyond your ability to help.
3
I have cared for three dying people and devoted myself every night and every weekend, and you'd have to ask my own sister who was there every step of the way if I did my part. Cancer is a messy, painful, awful way to die. We mortgaged our house so that we could keep my father home to die because he hated the hospital and when my mother died, he did not have enough income to pay his house payments. I was glad to do this. Four people in my immediate family died in a calendar year (my sister lost her own son a year later to an IED in Afghanistan). But this is a chronic condition. If the "best doctors, health workers, and therapists" cannot give her a fulfilling life, pray tell how can her loving sister or an advice columnist? How can she know how much of this has to do with the mental illness. I think my compassion for the sister--who seems to have no quality of life herself right now--is not callous, but a recognition that we cannot carry the suffering of others, no matter how much we try. I did not suggest abandoning her. But what will the next twenty years be like for her unless she also figures out how to get the support SHE needs? That was all I meant. Perhaps you judge people awfully easy--what is callous, what is fulfilling, whether pain treatment might go along way toward helping alleviate suffering. I assume the decision to "help" someone die was made after great soul searching. You know nothing about me. :)
3
Wrong answer on the possible suicide, many of us would say. There's no easy answer, since "laws" are involved. This patient wants out, and the doctors are not helping, not successful. The doctors, and much of USA society, have been trained to think that dying/death is worse than what this patient is enduring.
I know what I'd want, no question.
And imagine the money that is being spent by the family or by society. Who wants to "spend it all on doctors."
But there's a prison sentence, if the sibling is not extremely careful.
Or get some other doctors.
I know what I'd want, no question.
And imagine the money that is being spent by the family or by society. Who wants to "spend it all on doctors."
But there's a prison sentence, if the sibling is not extremely careful.
Or get some other doctors.
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I think someone has to do due diligence, and plan very carefully. There was a death in my wife's family home, and the police tried very hard to blame the family.
3
There is an organization called the Hemlock Society which can guide someone in their right to die.
1
It has been my experience that a religious groups frequently exploit staff and couch the effort in some kind of "good will" draping. Everyone knows that decent wages are an obvious sign of greed. Nothing surprising here. There's a reason that such organizations are the employer of last resort, and sadly some of the best people I have even known have worked in such organizations.
About notifying someone who is ill that a breakup is impending, you might be guided by Newt Gingrich. I believe he has some experience with that.
About notifying someone who is ill that a breakup is impending, you might be guided by Newt Gingrich. I believe he has some experience with that.
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LW 3 In my experience, people who swear you to secrecy before telling you something are usually manipulating you and usually asking you to do something they know you won't want to. I don't agree to this anymore. The worst one in my life was someone who made me promise and then told me they had a 3 year old child no one knew about. He repeated this a decade later - another child his family didn't know existed. All this came out when he died.
LW1 Theoretically yes. But we live in a climate where the law says you could and should be prosecuted and your sister's deficits and (I assume) diagnosed paranoid schizophrenia could raise an argument that she wasn't competent to decide to die. Proceed with extreme caution. If this goes wrong, you have much to lose.
LW1 Theoretically yes. But we live in a climate where the law says you could and should be prosecuted and your sister's deficits and (I assume) diagnosed paranoid schizophrenia could raise an argument that she wasn't competent to decide to die. Proceed with extreme caution. If this goes wrong, you have much to lose.
20
Dear Prof. Appiah,
"Name Withheld" wants to know if she should help her sister kill herself. Name says that Sister has one of the most severe mental illnesses there is--paranoid schizophrenia, characterized by psychosis, lack of ability to distinguish reality from delusion, and intensely vivid feelings of persecution.
From the letter, it seems that Sister's epilepsy and post-stroke physical and mental impairments contribute to Name's sense that Sister's pleas for help are the result of her physical situation, meriting death. You were too gentle with Name and her strong hints that she wishes her sister a speedy "death with dignity"--i.e., assisted suicide.
I'm sure you know that Oregon prepares a report, each year, on the reasons people give, for requesting suicide prescriptions. (No records are kept of people who request but are denied.) The requestor must have a diagnosis of a terminal illness with a prognosis of a 6-month life expectancy, on average. Even so, by far the most frequent reasons given for the request are “Losing autonomy” -- 91%; “Less able to engage in activities making life enjoyable” -- 86.7%; “Loss of dignity” -- 71%; “Burden on family” -- 40%. In other words, fear of disability.
This sounds like Sister's situation. She is disabled; she is inconsolable. She is not terminally ill, but Name wishes she were, because then, things would be easier. Poor Sister.
"Name Withheld" wants to know if she should help her sister kill herself. Name says that Sister has one of the most severe mental illnesses there is--paranoid schizophrenia, characterized by psychosis, lack of ability to distinguish reality from delusion, and intensely vivid feelings of persecution.
From the letter, it seems that Sister's epilepsy and post-stroke physical and mental impairments contribute to Name's sense that Sister's pleas for help are the result of her physical situation, meriting death. You were too gentle with Name and her strong hints that she wishes her sister a speedy "death with dignity"--i.e., assisted suicide.
I'm sure you know that Oregon prepares a report, each year, on the reasons people give, for requesting suicide prescriptions. (No records are kept of people who request but are denied.) The requestor must have a diagnosis of a terminal illness with a prognosis of a 6-month life expectancy, on average. Even so, by far the most frequent reasons given for the request are “Losing autonomy” -- 91%; “Less able to engage in activities making life enjoyable” -- 86.7%; “Loss of dignity” -- 71%; “Burden on family” -- 40%. In other words, fear of disability.
This sounds like Sister's situation. She is disabled; she is inconsolable. She is not terminally ill, but Name wishes she were, because then, things would be easier. Poor Sister.
17
Wow. Pretty heartless. It actually sounds like this sister is agonizing in a very difficult situation. And yes, one person's illness can cause suffering for many. And it is easier for some people to cope than for others.
You do not seem to have much sympathy for the people who are harmed by the illness other than the illness sufferer herself. I hope that you are not in a position to know how very hard it can be to be the sister in this situation.
You do not seem to have much sympathy for the people who are harmed by the illness other than the illness sufferer herself. I hope that you are not in a position to know how very hard it can be to be the sister in this situation.
4
A person who cries every night, frequently threatens suicide, and has attempted suicide several times is exhibiting many characteristics of someone who has a depressive disorder that is not just situational, but physiological, whatever her other difficulties. She deserves an evaluation by a competent psychiatrist and an antidepressant trial. Post stroke depression is not uncommon and treatable.
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To the author of the question about assisted suicide. I have deep sympathy for your plight. You might find this powerful article in the New Yorker to be of interest. wwwDOTnewyorkerDOTcom/magazine/2015/06/22/the-death-treatment
4
I'm surprised the Ethicist's answer to letter writer #1 was so limited. Even if the sister has the "best care," if the sister wants to help the place to start is to leave no stone unturned in finding medical solutions to her misery. Has every conceivable medication or treatment regimen been tried that might possibly address her depression, or control the epilepsy, or help manage the symptoms of schizophrenia? That's the road to go down, not the road to suicide.
14
Personally, I always ask: "Are you willing to keep a secret from X?" Only one person said no, because she told everything to her husband.
1
Failed suicide attempts are not a sign of wanting to live.
Helping a coworker to ask to be paid for work done is morally imperative.
Helping a coworker to ask to be paid for work done is morally imperative.
24
The woman who wishes to die and her brother should contact Compassion and Choices to learn about the options for aid in dying.
https://www.compassionandchoices.org/
https://www.compassionandchoices.org/
24
There is an acceptable path through this for the 50-year-old sibling and her family. They need to inform her fully about the voluntary dehydration option. I feel it's cruel to not inform her about this graceful option. She can then have independent control of her life. Becoming informed gave my wife, dying of cancer, great serene comfort. She chose this option.
21
It amazes me how starvation is considered a good option for dying with dignity. Certainly, it removes all doubt of anyone assisting with suicide, thus breaking the law (in most states), yet starvation is kind and gentle? True, as with my father, who was so drugged up he likely felt no pain, this is dignified? Perhaps the version for those without the ability to pay for all the meds should choose tequila?
Granted, each situation is unique, and as I well know, one's hands are quite well tied in respect to providing "hemlock"; my Dad wanted me to walk him out into the woods and "take care of him," which meant I had to stay away when he was ill because I would have done as he had asked. And paid a price.
So instead, he died "gracefully" by starvation, dehydration, and opiates.
With due respect, I doubt there is a single soul alive who can truly testify to this being painless, much less graceful.
We have much, much work to do in respect to dying with dignity and without pain.
Granted, each situation is unique, and as I well know, one's hands are quite well tied in respect to providing "hemlock"; my Dad wanted me to walk him out into the woods and "take care of him," which meant I had to stay away when he was ill because I would have done as he had asked. And paid a price.
So instead, he died "gracefully" by starvation, dehydration, and opiates.
With due respect, I doubt there is a single soul alive who can truly testify to this being painless, much less graceful.
We have much, much work to do in respect to dying with dignity and without pain.
1
This woman might not make the "right" decision about ending her own suffering because she is suffering? Let's get real. While a contingency plan should have been expressed in advance, as it should be for each of us, what remains now is for the sister and/or select others who are close to believe what the person says and provide the best means for her to carry out her own wishes. Of course since the govt currently frowns on this, all cautions must be taken. But then the question was what should I do, not how.
12
The complicating factor here for those around her is the paranoid schizophrenia. Her "reality," which she has shown in every conceivable way is one from which she desires permanent escape, is not one that her loved ones can reliably share, and a shared reality is the usual basis for determining competence to make such a decision.
My personal view is that the mental disability should not be allowed to deny her her agency. The fact is that she's tried a number of times to end her suffering. That she failed does not mean her attempts automatically fall into the "cry for help, but I don't really want to die" category. Her survival could be just a function of the fact that she has so much support right at hand.
I would argue she needs to be asked directly whether or not she's serious about wanting to die. If the answer is "Yes"--even if the yes is "coming" from her mental illness--then that needs to be respected and everyone should be informed that, should she decide to try again, that her wishes be respected and no attempt should be made to rescue her.
If those involved in her care can't keep their hands off legally, or don't agree she has the competence to make such a decision, then you're in the position of aiding her more directly, which I would argue is ethical.
My personal view is that the mental disability should not be allowed to deny her her agency. The fact is that she's tried a number of times to end her suffering. That she failed does not mean her attempts automatically fall into the "cry for help, but I don't really want to die" category. Her survival could be just a function of the fact that she has so much support right at hand.
I would argue she needs to be asked directly whether or not she's serious about wanting to die. If the answer is "Yes"--even if the yes is "coming" from her mental illness--then that needs to be respected and everyone should be informed that, should she decide to try again, that her wishes be respected and no attempt should be made to rescue her.
If those involved in her care can't keep their hands off legally, or don't agree she has the competence to make such a decision, then you're in the position of aiding her more directly, which I would argue is ethical.
4
I disagree with almost everything this ethicist writes, in every column besides today. He lives in a theoretical world when he writes this stuff, relying on lofty things like "justice" and seems to have little understanding for what happens on the ground. Regarding today though, it's very off-putting to a boss to have one employee push another to ask for "more." The relationship between an employer and an employee is only understood by those in the relationship. While there may (or may not) be some merit to asking to be paid for a favor, it is hardly a wise political move to run around telling other employees to ask the boss for more money if you see one doing the company a favor. I worked for free years ago and as a result was given a huge job. Had I nickel and dimed them for the tiny project, I would never have gotten the job. So what is 'right" here? Answer -- Appiah does not know. There are dozens of opportunities at jobs to be "right" and if you take them up you will alienate yourself from others. Imagine working at a big oil company -- you could just walk down a hall and get into it with every person you passed. Appiah has not held corporate jobs and in the ivory tower it is easy to make such errant judgments. We forgive him.
7
"I disagree with almost everything this ethicist writes. . ."
And I disagree with your entire answer. What part of "wage theft" do you not understand?
And I disagree with your entire answer. What part of "wage theft" do you not understand?
1
The point about the religious institution asking for favors is even more important. One reason nonprofits are generally less competent organizationally is that they get their work free in ways like this. That almost automatically excludes them from top talent (except perhaps at the board level, where payment is in prestige).
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