Assisted Suicide, Mental Health, and the Need for Better Stories
Zoraya ter Beek had fought a long battle with mental illness. Growing up in a small town in The Netherlands, she was tormented with suicidal thoughts even as a young child. At twenty-one, Zoraya was diagnosed with autism. In addition to autism, she suffered with border-line personality disorder and had been through multiple types of therapy. By her late twenties’, Zoraya was deeply discouraged. Her boyfriend had encouraged her to get help, but she was still struggling with what she described as a “blackness” on the inside. The desire to die was something that Zoraya had lived with since childhood. In many ways, death and hopelessness had become intertwined with her personality. As an outward marker of her pain, she had a tattoo of a tree on her upper left arm. While this “tree of life” that was stamped on her arm is typically a symbol of life and flourishing, Zoraya’s tattoo was different: it was upside down. The upside-down tree was her way of articulating a yearning to die. As the leaves fell off the tree and its roots slowly eroded, the tree was freed from its existence on this Earth. This was how she experienced life. Despite the darkness that seemed to invade her identity, however, Zoraya was still afraid to die. When asked how she felt, she responded that death was the “ultimate unknown… that’s the scary part.”
At only twenty-nine years old, Zoraya made the decision last Spring to end her life. In her last moments, Zoraya took a selfie in the company of her boyfriend as she reclined on the couch in her home. She didn’t have many friends and she was largely estranged from her family. She had decided to be cremated because she didn’t want a grave her boyfriend would have to attend to. Although not yet thirty years old, she simply didn’t want to live any longer with the limitations her mental health imposed on her.
A New Landscape of Death
Unfortunately, this is not an uncommon story. Suicides throughout the developed world are on the rise. In the United States alone, nearly fifty thousand Americans ended their life in 2022. The statistics are shocking, but the story of Zoraya is unique in that she did not carry it out herself. Zoraya’s death was supported and assisted by euthanasia laws in her country that are becoming more popular throughout the world. While euthanasia has historically been a discussion for people facing terminal illnesses, a new group of people are seeking this option for pain caused by anxiety and depression. When asked, many of these people cite current world issues like climate change, economic uncertainty, and the stress created by social media as the drivers of their suffering. In a development that would have been almost unthinkable twenty years ago, world governments are helping those with treatable issues commit suicide.
Euthanasia laws, particularly for mental health, represent a dramatic shift in the way the Western world views ethics. While The Netherlands, the home country of Zoraya, have the most radical euthanasia laws, other nations are passing legislation that make assisted suicide legal for mental health issues. Although a significant number of nations allow the practice for terminal illness, Belgium and Switzerland have joined The Netherlands in allowing assisted suicide for emotional disorders. According to Stef Groenewoud, an ethicist in The Netherlands, euthanasia is now seen as an acceptable “option brought to the table by physicians, when previously it was a last resort.” One of the reasons for this change, according to Groenewould, is that “healthcare professionals seem to give up on them more easily than before.” In some cases, death by suicide has become almost glorified. Theo Boer, a faculty member at Protestant Theological University in Groningen, served on the euthanasia review board for the Netherlands from 2005 until 2014. Boer describesa shift from death being seen as a last option to becoming the default option of choice among many medical professionals. In addition to a social media culture that glamorizes suicide and the rhetoric of radical right-to-die activists, the medical profession has helped to create an environment in the Netherlands were suicide is no longer stigmatized. According to these activists, death should be an option whenever someone feels as though their life is “complete.”
The Shift to Autonomy
For people who see the world largely through a more hopeful lens influenced by Christianity, this type of state action seems unthinkable. After all, significant evidence exists that points to mental health disorders being treatable. In addition, most people know someone who has battled a period of despair only to come out stronger on the other side. Despite the initial bewilderment over these laws, however, a more careful look at the culture’s trajectory will help make sense of this development.
The postmodern world has become adept at disentangling religious and moral norms from the larger ethical conversations in the West. The self, rather than community or historical norms, has become the standard of ethics. According to theologian Carl Truman, “Western society is built on the myth that individuals are in charge of their identities.” With humans in charge of building a sense of self, the opportunities for identity become endless. In this new world, characteristics of self that were once seen as periphery to our identity now can become the defining feature of our existence. This change combined with the pressure individuals feel to achieve relevance on social media has the possibility of leading people to undesirable ends. While I do not wish to negate any of the suffering that Zoraya ter Been experienced, suicide had attached itself to her identity. As a described activist for euthanasia with a “do not resuscitate” necklace drapped around her neck, this identity gave her suffering some type of meaning. As she posted before her death, she saw death as an honorable way to “provide insights to people who were open to learning something.”
The change in ethics at the root of euthanasia for mental health disorders points to a troubling development. For people who value life and believe in the intrinsic worth of human beings, a concerning truth is becoming clear: in much of the Western world, the narrative we are telling has been rejected. Same-sex marriages, gender reassignment surgeries, and polyamorous relationships are just a few examples of a new narrative surpassing the traditional Judeo-Christian view. While this is nothing new, the embrace of euthanasia points to something even more troubling. It appears as though a few Western societies have come to the logical end of the slippery-slope autonomy has delivered. If history is instructive, the rest of the West should take notice.
Fighting Story with Story
It is not as though this conversation has been left unattended to as academics have weighed in with moral and theological rebuttals. In the Catholic Herald, writer Beatrice Scudeler offered an array of well-reasoned arguments against the practice of assisted suicide. One of Scudeler’s strongest arguments was that assisted suicide actually limits the autonomy of the individual rather than strengthening it. While euthanasia laws claim to give power to the sufferer, it is a monumental surrender of control to the State. In making her argument, Scudeler points to the fact that ninety-nine percent of patients are reluctant to self-administer the life ending drugs. In most cases, a state-endorsed medical professional is the one injecting the cocktail. According to Scudeler, this indicates at least some reluctance of the person to kill themselves. Instead of a compassionate approach to suffering, Scudeler sees assisted suicide as a new twisted variation on an old play - the power-grab of the state.
In a similarly thoughtful article in First Things, Sam Buntz explores the history of assisted suicide and highlights the troubling link between Fascist regimes like the Nazis and support for euthanasia. Buntz main concern is that euthanasia laws aimed at mental health have fundamentally changed the definition of medical “care.” When the definition of “care” is as broad to encompass assisting in suicide, the limitations on the state have all but disappeared. In a particularly troubling anecdote, Buntz writes of a new push some Canadian lawmakers are behind. Since euthanasia is already so popular in that country, some think it should be used on people whose care is deemed too expensive. It is not hard to imagine a world where this type of “care” is used on the elderly and disabled. Just as the Nazis once described their gas chambers as the most “humane” option, assisted suicide opens and ever evolving conversation around how euthanasia should be used. As history has proven, this type of power should be frightening.
While intellectual arguments are necessary, the problem is that these arguments alone often fail to push the needle of public opinion. Conservatives have valiantly fought back against other threats to traditional norms only to suffer a resounding loss in the larger society. Perhaps the best example of this can be seen in the conservative pushback against same-sex marriage. The arguments made in the 2000’s against same-sex marriage certainly did not lack intellectual firepower. In an article by Ryan T. Anderson, Sherif Girgis, and Robert P. George, a fantastic case was made against same-sex marriage based on natural law. In what is a strong historic and moral argument for traditional views of marriage, the article maintained that the preeminent role of marriage is for procreation. Society, therefore, has a strong interest in protecting the traditional definition of marriage going forward. Despite this and other well-reasoned arguments, the West in 2024 is a culture supportive of same-sex marriage which has now been protected by the Supreme Court. Even more surprising to someone who came of age in the 2000’s like me, the debate is mostly over. Conservatives in this situation lost.
The connection same-sex marriage has to euthanasia is profound. Both movements are based on stories that capture the imaginations of the population. During the 2000’s while conservatives were making well-reasoned arguments in the public square, millions of Americans were tuning in each week to watch the hit sitcom “Will and Grace.” Despite the conservative case, Americans were being won over by the likable gay men that starred in the popular television show. The argument that ultimately won the day was one of autonomy. Why shouldn’t those attracted to the same sex have the right to happiness? After all, if the individual is autonomous to create their own identity, the rejection of this identity is rejecting the entire person. My fear is that this same storyline is being told in Western nations around assisted suicide. If identity is as flexible as mainstream society suggests, what do we make of someone whose identity can be described as “suicidal?” How can one argue against someone’s experience of pain? These types of stories can only be fought with a better story. The good news is that conservatives can unite to offer a more truthful and hopeful story to our culture.
In the case of Zoraya ter Beer, the last straw in her battle with mental health came from her psychiatrist. After trying several treatments, Zoraya was told by her health provider that there was no hope of her ever getting better. Due to the words of a fallible human being with no ability to see the future, Zoraya was convinced that she would never get better. For advocates of euthanasia for mental health, this is the story that is being told: some people will never get better and therefore it is acceptable to end your life. This story is simply not true. Because of this, I will end with my story suffering from a mental health disorder in hopes that it will contribute to a more realistic and hopeful narrative. For those who care want to see young lives like Zoraya’s protected, there is a need for more stories like this to be shared.
My Story
There have been at least three seasons in my life when I didn’t want to live anymore. When I read about the experiences of people like Zoraya ter Beer, I can empathize with her situation. My experiences have been marked by anxiety and depression that made life intolerable for long seasons of life. This suffering was exacerbated by a negative reaction to the medication designed to treat the issue. I have, like Zoraya, sat in the office of a medical professional who had little hope for my future. If hopelessness is measured on a spectrum, I would imagine that my outlook would have registered on the extreme side of things. In one of these episodes, I suffered with a condition known as akathisia for three months. Akathisia, which is an internal restlessness that makes it impossible for a sufferer to sit still, makes any possibility of normal living unattainable. In these months of pure hell, it was not uncommon for me to log twelve to thirteen miles of walking each day. Unfortunately, night offered little rest as I was unable to sleep.
I do not share this experience for sympathy. In many ways I was blessed to have a faithful wife, a strong church community, and supportive friends to fight for hope. Without this type of support, I do not know what would have become of me. The foundational piece to my survival was the stories I was told. Each day my family searched the internet for accounts of people that had made it through. The stories were of people like me who had much to live for but had lost their ability to function. In this state, academic arguments against suicide meant very little. What I needed was hope and quotations of theologians and philosophers did little to convince me life was worth living. Instead of academia, the healing came through stories of regular people who had emerged through the fire with a new perspective.
The recovery, particularly in my last bout with suffering, was slow. In many ways I am still recovering from the experience. One thing is certain; however, I am glad that I am alive. The stories I was told allowed me to keep fighting on dark days when light was nowhere to be seen.
For those who are concerned about assisted suicide, the weapon of story must be added to the arsenal. Appeals rooted in theology, sociology, and morality must also continue. As I recovered, these types of arguments made more sense and greatly helped me on my journey. Moreover, this type of work provides an intellectual foundation to build from. The problem that faced conservatives in the 2000’s, however, is being faced once again in the battle for the lives of those with mental health issues. Entire nations and a growing number of states in the U.S. are buying the lie that proponents of euthanasia are selling. Experts in mental health are quenching hope around a problem they do not fully understand. These lies must be combatted. For those who have battled mental health and are grateful that they survived, an important service to society is needed. It’s time to add another weapon to the fight for life. Will your story be that weapon?
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