Did you know that …
… there is no such thing as a “healthy person who wants to die”?
In Switzerland, it was long disputed whether assisted suicide was also permissible for people who do not have an illness in the medical sense. This question has now been clarified. Dr Pierre Beck, former President of EXIT Suisse romande, had provided assisted suicide for an 86-year-old woman who was supposedly healthy, together with her seriously ill husband. The elderly wife had decided that she did not want to continue living without her husband under any circumstances. The case was scrutinized by various courts and no violation of applicable law was found by the Federal Supreme Court.
It should be noted in this context that a serious suffering can also exist even if there is no medical diagnosis as defined in the ICD and ICF classification tables. This also follows from the constitution of the World Health Organisation (WHO): “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” [1]. The well-being and thus quality of life of someone who, like the woman in Dr Pierre Beck’s case, does not wish to continue living is undoubtedly impaired and the person cannot be considered “healthy” in the sense of this definition.
Someone who wishes to end their life by doctor-supported professional assistance in suicide due to existential suffering is always faced with the challenge to objectivate the suffering they experience subjectively, thus making their end-of-life choice comprehensible for those assisting – medical doctor, DIGNITAS, authorities, next-of-kin.
[1] https://www.who.int/about/governance/constitution
… grief is not necessarily a linear process with a defined starting and end point?
Grief typically has a clear starting point, for example the loss of a loved one, the expulsion from one’s home country, a serious diagnosis, or the decision of a close person for assisted suicide. In most cases, it does not have a clear end point. It does, however, transform.
Often, grief is discussed in terms of “stages” – a popular model being Elisabeth Kübler-Ross’s, which describes the five stages denial, anger, bargaining, depression, and acceptance. Although Kübler-Ross’s model originally referred to the dying process, it is often applied to the grieving process. According to this model, the stages of grief will ideally be experienced sequentially, with acceptance being the final stage. A common assumption is that one should confront one’s own grief and accept the situation at the end of the grieving process. This perspective is associated with the basic assumption that the loss of a close person is being mourned. At the same time, there is the notion that a person’s grief will eventually be over, and that one will “go back to normal”, i.e. things will be as they were before the event that led to grief.
However, people in grief will realize that grief is not linear and that it comes and goes in waves, in surges; and that there is no clear endpoint to it. Its quality often changes over time: it becomes less overwhelming than at the beginning, the intervals between surges lengthen, and it becomes easier to accept the situation. Grief is thus an individual, multifaceted, and complex process for which there are essentially no rules. It can last for months, even years, and for most people, there remains a “residual grief”. Notably, some individuals hardly mourn, and/or they experience grief only briefly. This perspective aligns with current research, with an important figure in this context being George A. Bonanno, a professor at the Loss, Trauma, and Emotion Lab[1] at Teachers College, Columbia University.
In dealing with grief, many things are entirely “normal”, albeit always individual. There is no right or wrong; both the nature and duration of the grieving process depend heavily on the actual event causing the grief and/or the relationship with the lost person. However, if it is no longer possible to cope with everyday life, to feel joy or to pursue a job, it may be advisable to seek professional support, as this could be signs of a “prolonged grief disorder”. The World Health Organization’s “International Classification of Diseases and Related Health Problems” (ICD), states that “prolonged grief disorder” includes “significant impairment in personal, family, social, educational, occupational or other important areas of functioning”[2].
In any case, it is important to give grief the space and time it needs. Although not pleasant, it is, as much as joy, part of life.
[1] https://www.tc.columbia.edu/ltelab/
[2] ICD-11 “prolonged grief disorder”
https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1183832314
Note: On 30 September 2023, DIGNITAS participated in a panel discussion “How do we talk about grief?” at the Festival of Ideas in Leeds. Click here for more information.