Are the Depressed Capable of Rational Suicide?

Ariane Bakhtiar

Presented by Ariane Bakhtiar.

In this paper, I argue that some of the suicidally depressed have decision-making capacity and can commit what is known as “rational suicide.”

Rational suicide, while having different definitions, generally means that a person makes a decision about dying while not impaired by a psychiatric disorder. There is some consensus in the literature on medical assistance in dying (MAiD) that the suicidally depressed requesting for assistance in death cannot have decisional authority regarding their wish to die. This is because the patient requesting to die is not medically competent given the nature of depressive psychopathology, e.g., depression as a lack of self-regard or concern for oneself, alienation from future possibilities, depletion of mental resources, and/or épuisement. Any of these theories might indicate a lack of insight into one’s condition in the context of decision-making capacity assessments, i.e., a physician’s assessment of a patient’s ability to make decisions about their medical condition and related treatment options (like decisions about MAiD).

Drawing on the clinical case of Janet who suffers from treatment-resistant depression, as well as theories on the nature of capacity, I argue that the suicidally depressed can have insight into their condition insofar as they have accurate appraisals about their wish to die separate from their symptomology. Thus, having a disorder does necessarily not preclude one from rational suicide. The mental disorder need not be all-encompassing and can allow for decisions about suicide that are not related to symptomology but to a well-reasoned decision about life with a grievous condition.