Why does life seem so unbearable one day

Suicide is not an act of autonomous self-determination

Dr. Klesse, you are a specialist in psychiatry and president of the "Hippocratic Society of Switzerland" and have been dealing with topics such as suicidality and euthanasia for decades. Can people want to die?

We humans have a natural will to live. We like to live and hope that our situation will improve in difficult times. But there can be situations that shake and overwhelm a person and cause great mental or physical suffering. That can be the loss of a loved one who doesn't seem manageable. Illnesses can confront a person with pain or severe physical stress. Age often brings with it discomfort and limitations. Accepting help can be a great challenge, especially for able people who have enjoyed being active and helping others. You can get into a mental emergency that seems so unbearable or insoluble to you at the moment that you think about wanting to die. Today there is also a penetrating and unspeakable discussion about health costs. It makes many old people feel that they do not want to be a burden on their children and society. Those who are no longer active, young and independent are increasingly perceived as a cost factor. As a result, old people in particular no longer feel welcome in our society. When these people talk about dying, it usually means that they no longer want to live "like this". When they regain hope and regain courage, they no longer want to die. Even after attempting suicide, 70 to 100 percent of those rescued do not make a second attempt. During follow-up examinations, many people have lost their desire to commit suicide. They have found their way again in life.

So the often alleged balance sheet suicide doesn't even exist?

The accounting suicide is a theoretical construct. There are people who, in inner loneliness and mental constriction, make a suicide decision and also carry it out. At a certain point in time, they no longer give their fellow human beings a chance to help them out of the crisis. These cases are rare. We almost always have the opportunity to help someone out of their misery if we recognize them in time.

Then what is to be done?

A suicidal person needs an echo immediately and his worries must be received. By people who are absolutely certain that (su) killing can never be the solution to human problems. A resonance in the discouragement increases the despair. That is why you need to talk to specialists who recognize the inner plight of the suicide. The sufferer has the right to human sympathy and needs confidence from the helper that together they will find a way out of the unbearable state. The suicide prevention institutions are doing an excellent job here.

With their demand for euthanasia in church institutions, two Protestant theologians have drawn attention. The press spokesman for the German Bishops' Conference rejects the demand. Life rights activists are also shocked.

So is suicidality curable?

Yes! But: Suicidality is not a disease, but an emotional state that is very unstable and can change again at any time if a person draws hope and is not abandoned in his desperation. But this requires a trusting relationship and concrete help to improve the situation, which is experienced as unbearable, together. This can mean helping a person deal with an illness, alleviating the pain professionally and ensuring that the ailment is adequately treated. This can be human support that helps a person through losses or bitter life experiences. This can help to find out together with the person affected what brought them into emotional distress and what a further meaningful way of life could look like. Some people are very convinced that there are no more ways to change their situation. It takes persistence and the unshakable certainty that people don't really want to kill themselves. And above all, to be present when the other person needs you.

Those involved in suicide prevention claim that suicidality is contagious. How would you describe that?

Suicides can lead to copycat acts. This happens especially when the media report extensively and sensationally about suicides or well-known personalities take their own lives. Others then adopt suicide as a model for "problem solving" in difficult life situations. One speaks here of the so-called Werther effect. In Western societies we have the problem that widespread propaganda for assisted suicide has been practiced in the media for thirty years. Feature films, evening series, talk shows as well as reports in radio broadcasts, newspapers, magazines and specialist magazines discuss the absurd alleged right to (su )icide. As a result, assisted suicides more than tripled in Switzerland between 2010 and 2018 alone. And this in addition to the other suicides. There are now more assisted than unassisted suicides in this country.

It is noticeable that in countries in which medically assisted suicide and / or "killing on request" has been legalized, parliaments often did not take the initiative. Instead, "right-to-die-societies" have brought individual cases to the highest courts. Their judgments then forced the parliaments to legislate. With "Exit" and "Dignitas" two of these associations are based in Switzerland. Does the system?

Yes. In 1980 the "World Federation of Right to Die Societies" was founded, of which most of the suicide organizations are members. Their declared aim is to influence the legal situation all over the world in order to legalize so-called "self-determined death" which also includes killing on request. But these organizations can only work as long as the citizens and the law allow it.

Representatives of the right-to-die societies stage themselves as people who spare others extreme suffering. Now it seems that they no longer want to see their postulated "right to self-determined death" linked to fatal illnesses and great pain. In the Netherlands, euthanasia is now to be made possible for those who are sick of life, in Canada the chronically ill. Were we led behind the spruce?

Anyone who takes the step of viewing other people's lives as no longer worth living is stepping onto the inclined plane of euthanasia. It starts with the public talking about killing. This includes the exaggeration of (suicide) as suicide. The resulting social mood puts pressure on old and sick people to stop being a burden. Lobby groups are calling for more and more groups of people to be included in the killing activities: people with dementia, the mentally ill, the frail and finally healthy "tired of life". The step from assisted suicide to killing on demand is then not far. In the Netherlands, a woman with dementia was recently killed despite resistance. The courts subsequently approved it. In Belgium there is now talk of a "banalization" of euthanasia, which goes hand in hand with a desolidarization and destruction of the moral values ​​of society. The pressure on doctors and health workers to participate is increasing. Experiencing and tolerating acts of killing leads to long-term emotional harm to an ever larger part of the population.

In its judgment of February 26, 2020, the Federal Constitutional Court speaks of a "right to self-determined death". "The decision of the individual to put an end to life in accordance with his understanding of the meaningfulness of his own existence" should be recognized as an "act of autonomous self-determination." Are the Karlsruhe judges based on a fiction from a psychiatric point of view?

"Doctors for Life" appalled by open attack on freedom of conscience. ALfA laments paradigm shift for Germany. CDL speaks of one of the darkest hours of German jurisprudence. - Reactions to the judgment of the Federal Constitutional Court on § 217 STGB. (Part 3 of 3)

I am appalled by this judgment. The German Basic Law was created after the war with the intention that never more life should be judged as "unworthy of life" and destroyed. The Federal Constitutional Court itself, which is supposed to guarantee the unconditional protection of life by the state and the constitution, has now broken precisely this protection. This process is a serious threat to the foundations of social coexistence. By giving everyone unrestricted access to assisted suicide in every phase of life, citing a "self-determination" that is detached from their fellow human beings, the court opens the floodgates for the previously described inclined plane of euthanasia. It is also worrying that the Federal Constitutional Court's ruling has completely disregarded the scientific principles that experienced psychiatrists and palliative care practitioners have given it in detail. According to this, around ninety percent of people who commit suicide suffer from mental illness. Experience clearly shows that people in suicidal need can be helped. The National Suicide Prevention Program points out that the Federal Constitutional Court relies on a "multi-dimensional construct of free responsibility" for which no empirical research results are available. Taking one's own life is not an act of autonomous self-determination. Here the public discussion and the court decision ignore the fundamentals of human existence. People only develop an independent, self-determined personality in a secure relationship and bond with their fellow human beings. He is always in relationships and dependencies on others. The decision to commit suicide is also influenced by third parties, in one direction or the other.Often people who want to leave life lack the human echo that others still need them and judge their life as valuable and worth preserving. Anyone who affirms or remains silent about suicide as a way of solving human problems leaves the needy in the lurch.

What does it mean for the doctor-patient relationship when doctors accompany patients during suicide or even kill them with their own hands, as in the case of "killing on request"?

The doctor-patient relationship is based on trust. Trust can only arise when people can be sure that their counterpart will not harm them. Trust in the doctor is based on the "nil nocere": the doctor will never knowingly harm his patient. And it certainly will not kill him or contribute to his death. The Hippocratic Oath laid this down 2500 years ago. As the patient's fateful companion and friend, the doctor accompanies him in all life situations, no matter how difficult. And if the doctor himself doesn't know what to do next and is desperate, then he gets help and doesn't kill his patient. If he takes killing into his trade, trust in the doctor is irreversibly destroyed and he becomes, as Hufeland said, the most dangerous man in the state.

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