There is a new blood test which can predict with 90% accuracy whether someone will develop Alzheimer’s disease in the near future, see biomarkers for alzheimers . In this posting I want to examine one of the consequences of cheap and accurate tests for degenerative mental diseases. Dena Davis has given a talk many times that highlights some of these consequences, see Hastings Centre Bioethics Forum . She asks her audience to imagine two individuals, Manny and Sue. Manny was a little frail and died at 85. He was living independently until his death and mentally “all there.” Sue lived until she was 99. From the age of 88 she began a slow cognitive decline eventually becoming incontinent and unable to walk, speak, or feed herself. Davis then asks her audience to imagine who they would rather be, Manny or Sue. The audience always preferred Manny and someone only rarely chose Sue.
An effective test for Alzheimer’s disease would enable someone with a positive test to plan for his future. For instance he might want to arrange his finances, make plans for his care and write a last directive if he wants. He might also choose to spend his savings on travel or the other things he enjoys whilst he is still capable. Such a test would also give him one further choice to make and it is this choice which is highlighted by Davis I want to focus on. He could choose to end his life like Manny or like Sue. A positive test means he has a rational reason to commit suicide. Committing suicide would not be an irrational choice.
It might be objected it is never rational to commit suicide. However for a spy facing prolonged torture to be rapidly followed by death, suicide seems a rational choice. The same reasoning might apply for someone suffering from a painful incurable disease when the pain is such that it cannot be controlled. I have also argued that sometimes it might be rational for someone who has committed some terrible crime to commit suicide. Let us accept in some circumstances it is rational to commit suicide. My objector might now object these circumstances are very rare. However according to Alzheimer’s Society there are currently 800,000 people in the UK suffering from dementia, see alzheimer's statistics . It follows if an accurate test could be introduced for Alzheimer’s disease became widely available the circumstances in which someone could make a rational decision to commit suicide might not be rare.
It might be objected whilst it might be rational to commit suicide that none the less it would be wrong. It might for instance be rational for a criminal to commit a crime which benefits him and would remain undetected. It would however be wrong to commit such a crime. One reason why it would be wrong is that crime harms others. It might then be argued that even if committing suicide is rational the fact that it harms others makes it wrong. I would certainly agree that a parent who commits suicide leaving her children behind does something wrong. However if someone commits suicide after committing a number of murders and rapes then does he do any additional harm to others by committing suicide, see prisoners serving life sentences . I would suggest he does not. It follows his suicide is not wrong and that it might even be wrong to stop him doing so. It follows that sometimes it might be both rational and not wrong based on harm to others for someone to commit suicide. My objector might now argue that committing suicide is wrong for reasons other than harm to others. I would reject such an argument. I believe in Mill’s dictum that “That the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.” Moreover I believe any society that fails to accept the autonomous decisions of its members provided these decisions do not harm others is not a truly caring society. Such a society may care for its members; but someone may care for sheep. Caring about its members must of necessity involve respect and respect must involve accepting we are the sort of creatures who can determine our own future provided we don’t harm others.
I have argued that sometimes it might be both rational and not be wrong for someone to commit suicide. However in the case of Alzheimer’s disease my objector might argue even if it might be rational for someone to commit suicide it would still be wrong. I argued above there are some circumstances in which suicide is wrong. Indeed I would suggest suicide is wrong in most cases because of the harm it does to others. However if someone who will develop Alzheimer’s disease commits suicide is he really doing something wrong by harming others? Jennifer Hecht argues if someone commits suicide he harms the community he lives in because by committing suicide encourages others to do likewise (1). Firstly I would question whether someone who commits suicide because he has a terminal illness will develop Alzheimer’s disease would encourage suicide in general. This would mean Hecht objection would not apply to anyone who commits suicide because he is likely develop Alzheimer’s disease. Someone’s suicide in this situation may of course increase the suicide rate among those likely to suffer from similar conditions. Secondly should society make someone suffer because he might influence others? Should we for instance ban the sale of alcohol because its consumption might influence some people to drink unwisely? My objector might now argue someone who commits suicide because he will develop Alzheimer’s disease harms particular people, his family and friends, the people who love him. I accept his suicide will make those who love him sad. But he will make these people sad eventually anyway when he dies, his suicide merely brings this period of sadness forward. Does the fact he commits suicide increase this sadness? I can see no reason why it should. Does the fact he commits suicide mean his friends and family should feel rejected. Once again I can see no reason why this should be because as his disease takes hold his meaningful interactions with them will inevitably cease. In the light of the above I would suggest if someone commits suicide because he will develop Alzheimer’s disease does no wrong. I do however accept his timing is crucial as Davis does.
Let it be accepted that someone who will develop Alzheimer’s disease does no wrong if he commits suicide. I want to examine two consequences of accepting the above. Firstly would it be wrong to aid someone in this situation to commit suicide? Prima facie if someone engages in some enterprise which isn’t wrong how can it be wrong to aid him in his enterprise? I would suggest great care is needed in this situation. Care is needed because we must be sure any aid we offer is to help someone carry out his decision and does not influence him in making his decision. The two are easily confused. One option might be that before we aid someone in such a situation we should make sure he gives his informed consent. Adopting this option might mean only physician assisted suicide would seem to be possible. A better option might be only to provide the means for anyone in this condition to commit suicide once he has made a firm decision to do so. Secondly it might be objected that because of the sheer number of people who will develop Alzheimer’s disease that permitting such people the right to commit suicide would mean we would face an epidemic of suicides. I will only make two responses to the above. Firstly many people who will develop Alzheimer’s disease will not wish to commit suicide and I’m doubtful whether adopting such a policy would lead to an avalanche of suicides. Secondly even if such a policy leads to an epidemic of suicides the badness is in the disease not the wrongness of the suicides.
- Jennifer Hecht, 2014, Stay: A History of Suicide and the Philosophies Against It, Yale University Press.
