Saturday, February 7, 2015

Why I Support Death with Dignity and Physician-Assisted Suicide

It is better to kill oneself intentionally than to live unintentionally.

Life and death exist on a continuum. In each moment we are living but also dying. There can be a consciousness in every moment of our lives. There can also be a lack of consciousness. Being alive only because I have not yet died is not the most intentional way to be alive. Extending life through medical life-saving measures chosen as if there were no other choice or from an internal motivation of being afraid to die is not being intentional either.

We are all going to die. Let me repeat that: We are all going to die.

Yet we live in a culture in the United States that is very afraid of death. There is a huge stigma associated with the act of suicide or even someone considering suicide.

By advocating for individuals to have the right to choose their own death, I am not saying it is okay for our society to remain the way it is. Society alienates people and operates on scarcity, and often people have barely enough to survive.

Sometimes a person expresses the wish to die because they lack hope for their life and their future, given their circumstances. Just a few examples are being bullied in school, dealing with the numerous prejudices that exist in a callous society, being burdened with debt or difficulty in managing the complex capitalistic money systems and coping with severe depression. I believe there should be universal access to counseling, medication, and treatment for chemical dependency and other problems people face. Even more importantly, I support any movement to make this world more hospitable, more caring and more compassionate for individuals who are seeking help and not wanting to end their lives.

People worry that someone may have regrets or would change their mind about dying or suicide if they only were to live longer. But some people would choose consciously and intentionally to end their life and would not regret it or change their minds if they lived longer. They know within themselves that their time for being alive on this earth is over. This may be because they have a terminal illness, but it may be for other reasons. With all the stigma around suicide, it can be very challenging to claim this truth.

If we want to make it easier for people to not have regrets, we must empower people from youth on to know themselves fully and to question everything outside themselves, including the patronizing attempts to control whether they can end their lives. We should all be doing the very hard work of creating real social, racial, environmental and economic justice in the world, so that individuals can make choices in their lives from an abundance of options. But even if we had that abundance, we will all still die at some point, and having the autonomy to make decisions about our lives and bodies is part of that justice we should all be working toward.

People sometimes have regrets when choosing life-extending medical interventions. The complications and difficulties of the treatments can far outweigh the chance for a better quality of life. Life-saving measures can lead to life-damaging results, like serious infections, bed sores, chronic diarrhea or worse.

When I consider these possible outcomes and how they would affect someone’s quality of life, I know that choosing to die is not the worst option. I don’t believe that living at all costs is a better choice than suicide.

We have this one precious life, and really the only person who knows what we need to be doing in any moment is us.

If we can’t choose to die, we can’t fully choose to live.

To think that we should not have this choice to die is to suggest that we don’t get to have an internal truth about what we should really do in other moments as well. Our internal knowledge about so many things gets minimized and often erased in a culture that stamps out our intuition and our feelings and our autonomy. People question whether or not a woman can choose abortion without regrets. People question whether a transgender youth can choose hormones without regret. People question whether a sex worker can intentionally and consciously choose sex work and feel empowered. The fact that some do and some don’t, and we could not possibly know what is right for someone else to do, is a complexity we don’t seem to be able to live with.

Many actions, thoughts and words make up our lives, and some of them may contribute to our dying. What we eat, risks we take and even what seem like normal behaviors in a contemporary society like driving a car or consuming alcohol or going to a stressful office job may all contribute to our dying. Everything we do matters, and whether I die from a single act to end my life or daily acts that end my life, what matters to me the most is the level of consciousness and intentionality that goes into those acts.

We can enhance our lives, live fully, breathe deeply, take in nourishments, experience joy and play in many ways. I would argue that when we are not living fully, we are killing ourselves, killing our spirits, killing our emotions and the joy that we could have had. That is the tragic death in my mind. To be alive and not be living fully is far more tragic than any suicide.

Is it unrealistic to want to live in a world where people are fully alive? Why is it so hard to allow personal autonomy and personal empowerment? There is complexity in every single issue I have ever written or talked about, whether sex, money or death and dying. Why do we need to control so much of what people do with their bodies and with their lives when they are not harming anyone else?

Society tries to control what people do by creating laws and stigma around certain activities, but ultimately we cannot control people, nor should we want to, unless someone is really doing harm to someone else. There will always be the few brave individuals who blaze their own path even if they are stepping outside of the law or into public criticism. For those who choose to follow the status quo only because they are afraid to question it, there is a price to be paid that is even greater than being judged for being different or for stepping outside the norms. Choosing to do something that not everyone would choose is not harmful. It is simply different from the norm. It is time we embrace the diversity in all aspects of our living and, dare I say, our dying.

The assumption that someone is harming us by being selfish if they were to die by suicide presupposes that we are not harming each other in our living. Relationships hurt sometimes, and ultimately we can’t and shouldn’t try to control others in life or death. Being selfless is a wonderful thing when it can be done authentically. But no amount of giving to another individual at our own expense will feel good if we are not first and foremost being true to ourselves.

Whether giving to a child or an elderly person dependent on us, giving to a friend in need or a stranger on the street, whether sacrificing our life for another’s such as saving someone from a burning building, from drowning or from being run over by a car, none of this is inherently good unless it is coming out of our own internal strength and self-esteem, what we are truly able to give. So too with the decision to live or die, whether it is by declining medical attention or requesting medication from a physician or dying from our personal choices about how to live on this earth. Whichever way we choose, my hope is that it comes out of a truly authentic desire to make the choice to be alive or not be alive.

I am not enhancing anyone’s life, including my own, if I choose to stay alive because of society’s taboos or other people’s desires for me, when I would rather not continue living. That choice does not enhance my relationship with others or my quality of life. This is true whether it is an active suicide, physician-assisted suicide or declining medical intervention that is routinely accepted in a technologically advanced society.

Over thirty years ago I almost killed myself from active alcoholism and depression. I do not regret that I have been alive for the past thirty years. I also would not regret it had I died thirty years ago.

Yes, there would be some things I have experienced these past thirty years that I would have missed out on: the children I got to love and the friends I have met over the years and the wonderful experiences I have had traveling and the writing I have published.

The truth is I will die at some point anyway, and there will always be something else I could have experienced had I had one more day. Often, what is or what was is good enough. In a culture obsessed with wanting more, that is a difficult concept to embrace—the idea that we don’t always have to do more or be more or even live one more day if we believe that is not the right thing to do. I will always pay close attention to my internal wisdom on what choice I should make today about living and dying, just as I have every day for the past thirty plus years.

We are all going to die. Let me repeat that: We are all going to die.

Many self-destructive acts seem as if they are not suicidal, but in truth they may be, like drug and alcohol use, fast driving or risky activities of all kinds. I emphasize they may be self-destructive or suicidal. We really don’t know what goes through the mind of anyone, including that of a person who has died by suicide. We should not judge if we have not walked the exact same path that person has walked.

I could choose to die from just not treating a simple infection. Is that suicide? I could die from having an asthma attack and not calling 911. Is that suicide? I could die from losing my recovery from alcoholism and getting into a car accident while drunk. Is that suicide? I could die from eating poor nutrition or smoking cigarettes every day. Is that suicide?

I would rather make an intentional decision to die than to live half alive and only be alive because I didn’t have the courage to choose to die. Doing nothing is also a decision and not necessarily a better decision than doing something, even if the decision does not make sense to anyone else. And just because society would be more comfortable with an accidental suicide as opposed to an intentional suicide does not mean that I have to respect that distinction.

It is such a high priority to me to not be in pain and to have a good quality of life in every moment in which I live. As I age, should I encounter illness or pain that leads me to decide it’s not worth extending my life, I want to have the option to end my life with medicine that could ease that transition.

What I know from all of my sexuality education work over the past two decades is that if I wait for the world to get where I want to be, I will never be where I want to be. So I choose to proclaim my vision of how I want the world to be, even when that vision is yet to come to fruition in the world.

To honor how I want the world to be, I have embraced and advocated for self-pleasuring and the importance of the relationship with self. I have said that obligation is not love and friendship is just as important as any other relationship we could ever have. I have said that it does not matter what we do or say, as much as how we do or say it, and that includes how we die.

I don’t wait for society to catch up before I say we should legalize drugs and provide treatment for addictions. I don’t wait for society to agree before I say we should decriminalize prostitution and provide livable, decent jobs for all people in every country and address poverty so no one is taking any job (whether sex work or anything else) because they don’t have another option.

I recognize that my choices may seem unusual, but I question what appears to be an automatic reflex of choosing extreme medical intervention, and I wonder about a society where we allow it to happen just because we are afraid to let go and die. How I live in each moment and the experiences I have in each moment are such a high priority to me that I cannot even contemplate the need to live a really long life over having a good quality of life. I cannot contemplate making decisions out of a fear of dying rather than living fully and intentionally right now.

If my life were to end tomorrow, I can honestly say that the moments I have had so far have been meaningful. Yes, there are things I would miss if my life were to end soon. But as painful as life can be, it is much more painful when I do not let go. I live my life as best I can, so that when the day comes, I will be ready to let my life end. I do not wait to say or do what is most important to say and do in all of my meaningful relationships.

If it happens that I live a long life without illness, pain or hardship, I am open to it. But I say no to extravagant intervention along the way or life-saving measures and surgeries and expensive technology. I have to ask, Is that suicide? I also have to ask, How different is a denial of medical intervention from actively taking one’s life when there’s no terminal illness at all?

Copyright 2015 by Susan Miranda.  All rights reserved.  No part of this writing may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright holder. For reprint permission, email