never kill yourself

against assisted suicide

The UK looks set to vote in favour of legalising assisted suicide tomorrow. Arguments against this bill have been put forward by a wide coalition including disabled people, palliative care professionals and NHS workers. Louis Appleby, head of the National Suicide Prevention Strategy, has opposed the bill on the basis that it would undermine the basic principle of suicide prevention: that suicide is never a preferable option to living.

Arguments against assisted suicide have been made from many quarters; here, I want to focus on one which has received less attention and which is personally significant for me—the danger that legalisation would pose to chronically suicidal people. The passage of this bill would be a catastrophic and irreversible cultural shift which would endanger many more lives than those of the terminally ill people directly implicated. Overnight, suicide would go from a worst case scenario, something which the state is tasked with preventing, to a justifiable and understandable option, just one possibility among many—perhaps even the best option, if suffering is unbearable and if one feels a burden to one’s family or to the state.

A couple of days ago, Kim Leadbeater agreed that feeling like a burden was a ‘legitimate reason’ for accessing assisted suicide. If the state sanctions this notion, enshrines it in law and adopts it into the workings of the NHS, a crucial defence against suicidality will have been abandoned forever. This will be the case regardless of whether the eligibility criteria are eventually extended to disabled people and the mentally ill, as they have in other counties where assisted suicide has been legalised.

First, a bit of personal history. I first attempted suicide the night before my sixteenth birthday, turning sixteen in a hospital bed. I was discharged from CAMHS shortly afterwards on the basis that this was manipulative behaviour which made me too high-risk for treatment. At the time, I had an eating disorder and had been getting some counselling for depression. I recovered from the eating disorder, left home, passed my A-levels and went to university. Shortly after my nineteenth birthday, I was hospitalised after another suicide attempt. This time, I was diagnosed with borderline personality disorder (BPD), the criteria for which include recurrent suicidal behaviour. I was hospitalised for further suicide attempts in December 2021 and April of this year. I’ve also had two Section 136s, where police remove you to a ‘safe place’ for up to 24 hours, during episodes of suicidal behaviour.

For over a decade, then, I’ve been dealing with chronic suicidality. Sometimes this falls short of an attempt but manifests in reckless and self-destructive behaviour, putting myself in harm’s way because I don’t care if I live or die. More often, it’s been a constant, low-level presence in the background, a temptation that pops up whenever anything goes wrong. The downstream consequences of chronic suicidality are severe—it’s hard to plan for the future or make concerted efforts to improve your life when you’re always flirting with death. It causes serious difficulties in relationships, familial and otherwise, when the ‘threat’ of suicide is always on the table. It means that you never feel safe in your own body or with your own mind and never trust yourself as a competent adult; you think of yourself as dependent, reliant on a brutally degrading system of healthcare and support services to stop you from killing yourself. Even if you don’t go through with it, living as a suicidal person is unpleasant.

Now, I’ve developed skills to deal with it. I’m not actively suicidal—I love my life and I’m generally happy; I have many things to live for and, even in the worst times, I now tend to look for other solutions before contemplating killing myself. But the most important defence I have against suicidal ideation is making it completely unthinkable, banishing it to the realm of taboo and never, ever considering it as a plausible option.

A few months ago, I posted this tweet:

I was surprised how many people replied calling me irresponsible and arguing against the notion that any risk is better than dying. Many people saw death as a preferable outcome to going into debt. They think of suicide as an option among other options—not ideal, but maybe better than extreme poverty, prolonged suffering, disability and other negative circumstances. There was a time, while I was a teenager, when I shared this view. Many of my friends had severe mental illnesses—eating disorders, bipolar, BPD, schizophrenia—and we talked openly about suicide. I had to make peace with the idea that I might lose some of my friends and that, if they made this choice, it would be an understandable one, a valid alternative to extreme suffering.

This is not a view I hold anymore. In the intervening decade, I’ve lost three friends to suicide and comforted others after their friends or family members killed themselves. I’ve also seen friends whose lives were nothing more than years of inpatient hospitalisations and trauma go on to recover, go to university, find love, start families, and have lives beyond anything we could have imagined as teenagers. I can no longer think of suicide as an option among others. It’s the end of all options, the end of hope. It denies all the infinite possibilities of the future, the ways that life can change and improve in ways we can never foretell. One friend, given a terminal cancer diagnosis as a teenager, is still here a decade later.

In September, I was in an extremely bad situation, still dealing with the consequences of leaving an abusive relationship over a year previously and having lost my plans for the future—PhD, funding, accommodation, all that. I had nowhere to live and no idea what to do next. It felt like anything I tried came apart in my hands and I started thinking about suicide again. Instead of acting on it, I took my own advice and bought a one-way ticket to Mexico. I had no particular plan, just a thought that getting some sun and being away from Britain would do me some good. On my second day there, I met the man whom I’m currently living with in London. Within two months, my life has changed beyond recognition—I have a home with someone I love, a plan for the future, a fluffy cat. We go for dinner with our friends and out to book launches and I go to the library to write and feel safe and cared for. I came off my anxiety medication in the Caribbean and find that I no longer need it. But the only reason I’m here today, the only reason I have any of this, is because of the strong taboo I instituted in my mind against suicide, a taboo which has thus far been backed by social consensus and health policy (though not always in the actual practice of mental health services).

There have been several points over the last fourteen years when, if given the option, I would have gladly opted for assisted suicide. Nor would this decision have seemed incomprehensible from the point of view of those who’ve known me and the various services tasked with keeping me alive. At times, I’ve been completely unable to function independently. I’ve been homeless, reliant on disability benefits, considered too high-risk to mental health services, considered untreatable. I would never have believed limp platitudes like ‘it gets better’ or ‘it won’t be like this forever.’ When I got the BPD diagnosis, I was told that it was incurable and that my best hope was of managing it, day in day out, for the rest of my life, probably while on antipsychotics. Now the only medication I’m on is for ADHD and I no longer meet the criteria for BPD. I don’t use any mental health services and I’ve learnt to manage my moods, which are still difficult, through lifestyle changes. I’m so grateful that none of the suicide attempts stuck before I realised that a good life was possible.

When you’re deep in it, it’s very hard to argue against suicidal logic. The pros seem to vastly outnumber the cons. Living through each day is unbearably painful and you can see the pain and material damage you inflict on those who care for you. You’re a drain on state resources, the NHS has nothing to offer and considers you a nuisance who’d probably be better off dead, you lack the skills even to get dressed or feed yourself let alone change anything about your state of life. Loss of income and housing happens easily and it feels like nothing can stop the decline. It’s very difficult to feel hope or to attribute any value to your continued existence, which seems a net negative on every level. The only defence against going through with suicide is its not being on the table to start with.

The bill as currently proposed applies to those with terminal illnesses with six months to live. There are several issues with this: ‘terminal’ is not a foolproof diagnosis—many people live beyond terminal prognosis and assisted suicide on grounds of terminal illness is available for people with ‘end-stage’ anorexia in Canada, where it can be granted in 24 hours, and several US states. I recently watched a young woman liveblog her assisted suicide on an eating disorder forum, the thread descending into communal grief after her death. Even before the bill has passed, there are already calls to extend the criteria to cover non-terminal disability and mental illness. Once suicide is justified in principle, there is no convincing argument for not extending the ‘right to suicide’ to other groups. The six month line is arbitrary. Medical Assistance in Dying (MAID) was introduced in Canada in 2016 and was extended in 2021 to cover unbearable suffering. It is set to be extended to cover those with mental illnesses in three years’ time. In Switzerland, Belgium, the Netherlands, Austria and Spain, assisted suicide is already available on grounds of unbearable suffering. Last year the Netherlands extended its law to cover children of all ages.

Once you start thinking about suicide like this, as just one of a range of choices open to you, it becomes hard to resist. Especially if you’re disabled and reliant on the welfare state, it’s natural to think of suicide as the moral option—the option with the greatest overall utility. This is especially the case if your moral framework lacks a justification for thinking of life as valuable in itself. When you’re neither contributing to society nor deriving any enjoyment from life, what argument can you make for continuing to live? For me, a spiritual framework, like that outlined in Dignitas Infinita, has been essential. But most people aren’t spiritual and their only bulwark is the social consensus that life is preferable to death. This consensus is what’s up for debate tomorrow.

Even if the law isn’t extended to cover non-terminal grounds, legalising assisted suicide will destroy this consensus. You can’t approve of suicide on select grounds while continuing to discourage it in others without profound confusion, which will be played out on the level of policy as well as for individuals working within or accessing health services. As it stands, trying to access mental health services in the UK feels like being slowly incentivised to kill yourself. There are years-long waiting lists for therapy and the attitude of mental health professionals is often callous and cruel. Take, for instance, the Serenity Integrated Management approach taken to people with BPD until last year, where suicidal behaviour was criminalised and vulnerable people told explicitly that they should stop seeking help because they are drains on the NHS. It requires huge personal strength and support to reject this messaging and continue believing that your life is valuable, especially while dealing with severe mental illness and pathological suicidality. What we ask of these people is already almost impossible. Only 0.9% of the group assessed as having a ‘severe mental illnesses’ were receiving a psychological therapy as of April 2024. And instead of offering support, the government now proposes to make staying alive even harder.

Suicide, like other forms of self-destructive behaviour, is contagious. There’s an Anne Sexton poem, written after Sylvia Plath’s suicide, where she writes:

Thief!-
how did you crawl into,

crawl down alone
into the death I wanted so badly and for so long,

the death we said we both outgrew,
the one we wore on our skinny breasts,

the one we talked of so often each time
we downed three extra dry martinis in Boston,

the death that talked of analysts and cures,
the death that talked like brides with plots,

the death we drank to,
the motives and the quiet deed?

You can hear the jealousy in her voice. She did it eventually, of course. A chronically suicidal person will learn of someone’s suicide, even a friend’s, and inevitably feel a stab of envy. How come she got to do it, and not me? Why should I be stuck here?

Zoraya ter Beek, a twenty-nine year old Dutch woman, died earlier this year from assisted suicide. She had autism, depression, anxiety, trauma and an unspecified personality disorder. I did some reading into assisted dying on mental health grounds in the Netherlands and found this study reporting that only 1% of people approved for assisted dying/euthanasia for borderline personality disorder had been offered any kind of appropriate evidence-based therapy. Instead of offering treatment for one of the most treatable mental illnesses, the Netherlands is offering suicide as the first option—for a disorder where suicidality is among the diagnostic criteria. The unavoidable conclusion is that the Netherlands has decided that that these lives are not worth trying to save. Even teenagers are being euthanised on mental health grounds, forestalling any possibility of recovery and improvement in adulthood. When I tweeted about this, the negative responses hurt me more than I expected. Zoraya was my age when she died and had the same diagnoses that I’ve had. It felt like having to make a case for my own life. Some people told me to kill myself. Just participating in the argument—having to conceive of suicide as something to argue against rather than something beyond the pale of any reasonable debate—flicked the suicidal ideation switch in my brain back on.

If you Google ‘suicide town’, my hometown is one of the first results. The year I started at comprehensive school, a Welsh-medium school in the Rhondda valley, the girls’ toilets were makeshift shrines to teen suicide victims, RIPs and messages to the deceased carved into the metal stalls. We talked about suicide over lunch, eleven years old. An older boy in my street went to his friend’s funeral wearing one of those thin black emo ties and Funeral for a Friend, a local band, played a set there. I remember a flock of American journalists, writing for Vanity Fair, descending on my mum’s community project, which worked with young people who’d been excluded from school or got into trouble with the police. This is what they wrote:

Psychologists familiar with the phenomenon are saying that what’s going on in Wales is a classic case of the Werther effect, named for Goethe’s novel The Sorrows of Young Werther, about a young man who puts a gun to his head to end the agony of unrequited love and because he can’t find his place in the provincial bourgeois society of the day. The novel’s publication, in 1774, prompted young men all over Europe to dress like Werther and take their lives. It’s also called the contagion effect and copycat suicide: one person does it, and that lowers the threshold, making it easier and more permissible for the next. Like 10 people waiting at a crosswalk for the light to change, and one of them jaywalks. This gives the rest of them the go-ahead. {x}

In 2008, suicide prevention charity Papyrus called on the media to stop reporting on the Bridgend suicides, as did the local Labour MP. Newspaper articles cited a meta-study by the Centre for Suicide Research at Oxford which had found evidence of an increase in suicides after media reporting in twenty-one out of thirty cases, with ten studies showing a causal link between media reports and subsequent suicides. Reports where the method of suicide was detailed were identified as particularly dangerous. This is what’s called an infohazard—it’s not that a teenager reads about suicide and goes out and does it, but the information lurks in the brain, liable to pop up when future circumstances allow for it. It moves from the dark zone of taboo into a conceivable possibility, even a reasonable one.

The only defence I’ve found against chronic suicidality is to make it unthinkable, never an option, no matter how bad things get. This is my main objection to assisted suicide becoming law in the UK. If we accept that, for some people, suffering is so great and quality of life is so poor as to make suicide a valid, justifiable, even preferable option, then suicide will forever cross that boundary from taboo to rational choice. Once a right is granted it’s very difficult to revoke. Enshrining a right to suicide in law will initiate a cultural shift that can never be undone.

If you have some time this evening, please consider writing to your MP and encouraging them to vote against the bill. There are still a lot who are undecided and still a chance that it could be defeated. There’s a template which you can use here. There’s also a rally tomorrow outside parliament, beginning at 8.15am at the Statue of George V, Westminster, London, SW1P 3JY, organised by a coalition of groups including disability rights activists and medical professionals. Maybe I’ll see some of you there.