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Equal in the presence of death?
  1. Agata Sagan
  1. Correspondence to Agata Sagan; different185{at}

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When life ends, everything ends, at least for those who do not believe in an afterlife, so it is no wonder that decisions about ending life should be taken with as much seriousness and consideration as possible.

Most of the worries raised around ending the life of someone with treatment-resistant major depressive disorder seem to be justified. Could depression pass away or be cured with some new drug or therapy that is yet to come? Is his or her wish to die genuine, and not just a part of the disease? Will allowing depressed people to die not cause loss of hope and a cascade of suicides among others suffering from the same condition?

However, there are strong reasons for allowing people suffering from untreatable depression to end their lives. The primary reason is the severity of the suffering caused by depression. Many people with depression, and also many doctors and other carers, assess this suffering as worse than most forms of physical suffering. Moreover, for the suffering caused by depression, we do not have the kind of palliative care available which can, in most cases of physical suffering, eliminate the pain.

A second and perhaps even stronger reason why people with depression should be allowed to end their lives is that in most cases depressed people can't look forward to a ‘natural’ death that will soon release them from suffering. (Usually, though not always, people with severe physical suffering from an illness like cancer know that their suffering will not last long.) Despite suicidal thoughts appearing partly because of the tension of suffering, deep depression usually blocks people from doing anything. It is as if they are locked in a harsh prison ward with their unbearable pain and have no way to escape it.

When depressed people commit suicide it is often done suddenly, in agitation, and therefore without much attention to how it is to be carried out. Sometimes this can be fatal for others as when someone turns on the oven in order to gas him or herself, and that results in an explosion. Less tragic, but more common, are cases in which a train driver suffers the trauma of hitting someone who has chosen that means of committing suicide, or family members are shocked to find the body of someone they love.

Even those who do plan everything in advance are likely to fear that they will fail, or that their death will be painful. It has been estimated that about 90% of suicides fail, especially those committed by women, and some of these failures leave the person in an even worse position than he or she was before. For example, the person may have damaged organs and an even lower ability to work, earn and thus lead at least a minimally acceptable life. For this to happen to a person already suffering from depression is just dreadful.

It also needs to be said that not everyone can commit suicide. Quadriplegics with depression have no other way than to rely on others.

Errors in assessing who is eligible for assisted suicide will occur occasionally, but this is also true in cases of cancer and other illnesses, and should not stop us from letting people do what they want, even if it may suggest additional caution in accepting their request.

Depressed people are still stigmatised, although fortunately this is slowly changing now, as a result of a lot of campaigning. Often treatment is very expensive for them since getting insurance covering depression is still very difficult. In this extremely demanding situation, we take away even their right to give up the struggle. This is yet another terrible form of discriminating against them.

Implementing an option of assisted suicide for people with treatment-resistant major depressive disorder would guarantee them this absolute minimum, and might also ease, or even save, some lives. As in the case of those with physical illnesses, awareness that one can end the suffering whenever one wants to do so lowers stress and often actually allows people to live longer. (Not to mention that if every depressed person wishing to die would be honestly checked and given all available treatments, I am sure that a large percentage would not qualify for suicide. Only one-third of all depressed people get any treatment at all.) Additionally, if it were possible for another person to be present when a depressed person ends his or her life, this would provide an extra guarantee that if the person who wants to die should happen to change his or her mind at the very last minute, there will be someone there who will call for the ambulance.

Paradoxically by changing the law to allow people with depression to decide whether to go on living, we are not leaving the decision completely in their hands, as it is now.

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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