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Rationality and the wish to die—a response to Clarke
  1. Dr Christopher James Ryan, MBBS FRANZCP
  1. Consultation-Liaison Psychiatrist, University of Sydney and Department of Psychiatry, Westmead Hospital, Westmead, NSW 2145, Australia

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    In a scholarly and thought-provoking paper, Clarke sets out to debunk the concept of “rational suicide” as nonsensical.1 His motivation in this is to undermine any support that the notion of rational suicide might give to a “categorical right to suicide”. If his enterprise were successful, however, it would go far beyond the “rights issue” and would have a profound impact on all arguments raised in support of euthanasia or physician-assisted suicide.

    Clarke's major thrust might be termed the argument from posthumous ignorance. He begins with a claim that the process of making a rational decision involves the process of “gaining all possible facts and `imagining' all possible consequences”. He goes on to say that making a rational decision “in the consideration of life or death . . . would seem to be impossible”. It is “impossible” because the person making the decision cannot know what death is like, and therefore cannot weigh up the risks and benefits of his or her choice to die. One just can't know what it is like to be dead — “it is essentially of an unknown quality and a matter of faith rather then rational thought”.

    Before examining where Clarke has gone wrong, let us leave aside the obvious impossibility of gaining all possible facts and substitute the notion of gaining all relevant facts. Further, let us gloss over the considerable difficulties in deciding what counts as relevant, by allowing that knowing what it would be like to be dead would be relevant to a decision concerning the possibility of dying. Finally, let us overlook the fact that many of us feel we have a pretty good idea what death would be like anyway.

    It is quite common for people to make what we are happy to term rational decisions in situations where they do not and cannot know a fact of apparent primary relevancy. We do that the first time we make a rational decision to eat a mango. Of course, we may ask others what mangoes taste like—“sort of mangoey”—but we cannot know (in Clarke's strict sense) until we've done it ourselves. It would seem very odd to deprive any decision involving any novel activity of any possible rationality.

    Clarke might respond, of course, that we are talking about something far more unknowable than the taste of mango. No one knows what death is like. “Although one can imagine that death will be like dreamless sleep or being under anaesthetic, it is an assumption or at best a guess. Nobody knows.”2 Perhaps Clarke's position is that it is not possible to make a rational decision, where one of the relevant facts is not known (in Clarke's strict sense) by anybody.

    However, even this position will flounder. People make decisions, that we are happy to call rational, with exactly this limitation all the time. Nobody knows what the future will hold, but people make rational decisions that concern future possibilities. More specifically people make all sorts of rational decisions about issues that concern death. I have made a rational decision to take anti-hypertensive medication, primarily because I want to stave off death. People frequently decide to have life-saving operations for exactly the same reason. Others opt for treatments, such as bone marrow transplants, where death is a relevant possible adverse outcome. Clarke would presumably not argue that these decisions are necessarily non-rational, despite the fact that they must involve the consideration of the ultimately unknowable quality of death.

    It is not necessary to gain all relevant facts to make a rational decision, it is only necessary to gain those relevant facts that are reasonably obtainable and to have an understanding of the limits of one's knowledge. It is OK to guess, as long as you know that you are guessing. It is possible to make a rational decision about suicide.

    Clarke is right to caution us to be wary of the motives of those who ask to die. A genuine request to die uninfluenced by mental illness and based on a considered weighing of the pros and cons of continued life, is a very rare beast. Rare it may be, logically impossible it is not.

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