The simplest moral outlook on suicide holds that it is necessarily wrong because human life is sacred. Though this position is often associated with religious thinkers, especially Catholics, we find similar positions in Kant and in Ronald Dworkin. According to this ‘sanctity of life’ view, human life is inherently valuable and precious, demanding respect from others and reverence for oneself. Hence, suicide is wrong because it violates our moral duty to honor the inherent value of human life, regardless of the value of that life to others or to the person whose life it is. The sanctity of life view is thus a deontological position on suicide.
The great merit of the sanctity of life position is that it reflects a common moral sentiment, namely, that killing is wrong in itself. The chief difficulties for the sanctity of life position are these:
First, its proponents must be willing to apply the position consistently, which would also morally forbid controversial forms of killing such as capital punishment or killing in wartime. But it would also forbid forms of killing that seem intuitively reasonable, such as killing in self-defense. To accept the sanctity of life argument seems to require endorsing a thoroughgoing pacifism.
Secondly, the sanctity of life view must hold that life itself, wholly independent of the happiness whose life it is, is valuable. Many philosophers reject the notion that life is intrinsically valuable, since it suggests, e.g., that there is value in keeping alive an individual in a persistent vegetative state simply because she is biologically alive. It would also suggest that a life certain to be filled with limitless suffering and anguish is valuable just by virtue of being a human life. Peter Singer and others have argued against the sanctity of life position on the grounds that the value of a continuing life is not intrinsic but extrinsic, to be judged on the basis of the individual's likely future quality of life. If the value of a person's continued life is measured by its likely quality, then suicide may be permissible when that quality is low.
Finally, it is not obvious that adequate respect for the sanctity of human life prohibits ending a life, whether by suicide or other means. Those who engage in suicidal behavior when their future promises to be extraordinarily bleak do not necessarily exhibit insufficient regard for the sanctity of life. To end one's life before its natural end is not necessarily an insult to the value of life. Indeed, it may be argued that suicide may be life-affirming in those circumstances where medical or psychological conditions reduce individuals to shadows of their former fully capable selves.
Religious Arguments
Two general categories of arguments for the moral impermissibility of suicide have emerged from the Christian religious tradition. The first of these is the aforementioned Thomistic natural law tradition, critiqued by Hume. According to this tradition, suicide violates the natural law God has created to govern the natural world and human existence. This natural law can be conceived of in terms of (a) natural causal laws, such that suicide violates this causal order, (b) teleological laws, according to which all natural beings seek to preserve themselves, or (c) the laws governing human nature, from which it follows that suicide is ‘unnatural’. These natural law arguments are no longer the main focus of philosophical discussion, as they have been subjected to strenuous criticism by Hume and others. These criticisms include that the natural law arguments cannot be disentangled from a highly speculative theistic metaphysics; that these claims are not confirmed by observations of human nature (e.g., the existence of self-destructive human behaviors casts doubt on the claim that we "naturally" preserve ourselves); and that other acts (e.g., religious martyrdom) which God is assumed not to condemn, also violate these natural laws, making the prohibition on suicide appear arbitrary.
The second general category of religious arguments rest on analogies concerning the relationship between God and humanity. For the most part, these arguments aim to establish that God, and not human individuals, have the proper moral authority to determine the circumstances of their deaths. One historically prominent analogy (suggested by Aquinas and Locke) states that we are God's property and so suicide is a wrong to God akin to theft or destruction of property. This analogy seems weak on several fronts. First, if we are God's property, we are an odd sort of property, in that God apparently bestowed upon us free will that permits to act in ways that are inconsistent with God's wishes or intentions. It is difficult to see how an autonomous entity with free will can be subject to the kind of control or dominion to which other sorts of property are subject. Second, the argument appears to rest on the assumption that God does not wish his property destroyed. Yet given the traditional theistic conception of God as not lacking in any way, how could the destruction of something God owns (a human life) be a harm to God or to his interests? Third, it is difficult to reconcile this argument with the claim that God is all-loving. If a person's life is sufficiently bad, an all-loving God might permit his property to be destroyed through suicide. Finally, some have questioned the extent of the duties imposed by God's property right in us by arguing that the destruction of property might be morally justified in order to prevent significant harm to oneself. If the only available means to saving myself from a ticking bomb is to stash it in the trunk of the nearest car to dampen the blast, and the nearest car belongs to my neighbor, then destroying his property appears justified in order to avoid serious harm to myself. Likewise, if only by killing myself can I avoid a serious future harm to myself, I appear justified in destroying God's property (my life).
Another common analogy asserts that God bestows life upon us a gift, and it would be a mark of ingratitude or neglect to reject that gift by taking our lives. The obvious weakness with this "gift analogy" is that a gift, genuinely given, does not come with conditions such as that suggested by the analogy, i.e., once given, a gift becomes the property of its recipient and its giver no longer has any claim on what the recipient does with this gift. It may perhaps be imprudent to waste an especially valuable gift, but it does not appear to be unjust to a gift giver to do so. As Kluge put it, "a gift we cannot reject is not a gift". A variation of this line of argument holds that we owe God a debt of gratitude for our lives, and so to kill ourselves would be disrespectful or even insulting to God, or would amount to an irresponsible use of this gift. Yet this variation does not really evade the criticism directed at the first version: Even if we owe God a debt of gratitude, disposing of our lives does not seem inconsistent with our expressing gratitude for having lived at all. Furthermore, if a person's life is rife with misery and unhappiness, it is far from clear that she owes God much in the way of gratitude for this apparently ill-chosen "gift" of life. Defenders of the gift analogy must therefore offer a theodicy to defend the claim that life, because it is given to us by a loving God, is an expression of God's benevolent nature and is therefore necessarily a benefit to us.
In addition, there is a less recognized undercurrent of religious thought favoring suicide. For example, suicide permits us to reunite with deceased loved ones, allows us those who have been absolved of sin to assure their entrance to heaven, and releases the soul from the bondage of the body. In both Christian and Asian religious traditions, suicide holds the promise of a vision of, or union with, the divine.
Libertarian Views and the Right to Suicide
For libertarians, suicide is morally permissible because individuals enjoy a right to suicide. (It does not of course follow that suicide is necessarily rational or prudent.) Libertarianism, which has historical precedent in the Stoics and in Schopenhauer, is strongly associated with the ‘anti-psychiatry’ movement of the last half century. According to that movement's critics, attempts by the state or by the medical profession to interfere with suicidal behavior are essentially coercive attempts to pathologize morally permissible exercises of individual freedom.
Libertarianism typically asserts that the right to suicide is a right of noninterference, to wit, that others are morally barred from interfering with suicidal behavior. Some assert the stronger claim that the right to suicide is a liberty right, such that individuals have no duty not to commit suicide (i.e., that suicide violates no moral duties), or acclaim right, according to which other individuals are morally obliged not only not to interfere with a person's suicidal behavior but are in fact morally required to assist in that suicidal behavior. Our having a claim right to suicide implies that we also have rights of noninterference and of liberty and is a central worry about physician-assisted suicide.
A popular basis for the claim that we enjoy a right to suicide is the claim that we own our bodies and hence are morally permitted to dispose of them as we wish. On this view, our relationship to our bodies is like that of our relationship to other items over which we enjoy property rights: Just as our having a right to a wristwatch permits us to use, improve, and dispose of it as we wish, so too does our having a right to our bodies permit us to dispose of it as we see fit. Consequently, since property rights are exclusive (i.e., our having property rights to a thing prohibits others from interfering with it), others may not interfere with our efforts to end our lives. The notion of self-ownership invoked in this argument is quite murky, since what enables us to own ordinary material items is their metaphysical distinctness from us. We can own a wristwatch only because it is distinct from us, and even under the most dualistic views of human nature, our selves are not sufficiently distinct from our bodies to make ownership of the body by the self a plausible notion. Indeed, the fact that certain ways of treating ordinary property are not available to us as ways of treating our bodies (we cannot give away or sell our bodies in any literal sense) suggests that self-ownership may be only a metaphor meant to capture a deeper moral relationship. In addition, uses of one's property, including its destruction, can be harmful to others. Thus, in cases where suicide may harm others, we may be morally required to refrain from suicide.
Another rationale for a right of noninterference is the claim that we have a general right to decide those matters that are most intimately connected to our well-being, including the duration of our lives and the circumstances of our deaths. On this view, the right to suicide follows from a deeper right to self-determination, a right to shape the circumstances of our lives so long as we do not harm or imperil others. As presented in the "death with dignity" movement, the right to suicide is presented as the natural corollary of the right to life. That is, because individuals have the right not to be killed by others, the only person with the moral right to determine the circumstances of a person's death is that person herself and others are therefore barred from trying to prevent a person's efforts at self-inflicted death.
This position is open to at least two objections. First, it does not seem to follow from having a right to life that a person has a right to death, i.e., a right to take her own life. Because others are morally prohibited from killing me, it does not follow that anyone else, including myself, is permitted to kill me. This conclusion is made stronger if the right to life is inalienable, since in order for me to kill myself, I must first renounce my inalienable right to life, which I cannot do. It is at least possible that no one has the right to determine the circumstances of a person's death! Furthermore, as with the property-based argument, the right to self-determination is presumably circumscribed by the possibility of harm to others.
Social, Utilitarian, and Role-Based Arguments
A fourth approach to the question of suicide's permissibility asks not whether others may interfere with suicidal behavior but whether we have a liberty right to suicide, whether, that is, suicide violates any moral duties to others. Those who argue that suicide can violate our duties to others generally claim that suicide can harm either specific others (family, friends, etc.) or is a harm to the community as a whole.
No doubt the suicide of a family member or loved one produces a number of harmful psychological and economic effects. In addition to the usual grief, suicide "survivors" confront a complex array of feelings. Various forms of guilt are quite common, such as that arising from (a) the belief that one contributed to the suicidal person's anguish, or (b) the failure to recognize that anguish, or (c) the inability to prevent the suicidal act itself. Suicide also leads to rage, loneliness, and awareness of vulnerability in those left behind. Indeed, the sense that suicide is an essentially selfish act dominates many popular perceptions of suicide. Still, some of these reactions may be due to the strong stigma and shame associated with suicide, in which case these reactions cannot, without logical circularity, be invoked in arguments that suicide is wrong because it produces these psychological reactions. Suicide can also cause clear economic or material harm, as when the suicidal person leaves behind dependents unable to support themselves financially. Suicide can therefore be understood as a violation of the distinctive "role obligations" applicable to spouses, parents, and other caretakers. However, even if suicide is harmful to family members or loved ones, this does not support an absolute prohibition on suicide, since some suicides will leave behind few or no survivors, and among those that do, the extent of these harms is likely to differ such that the stronger these relationships are, the more harmful suicide is and the more likely it is to be morally wrong. Besides, from a utilitarian perspective, these harms would have to be weighed against the harms done to the would-be suicide by continuing to live a difficult or painful life. At most, the argument that suicide is a harm to family and to loved ones establishes that it is sometimes wrong.
A second brand of social argument echoes Aristotle in asserting that suicide is harm to the community or the state. One general form such arguments take is that because a community depends on the economic and social productivity of its members, its members have an obligation to contribute to their society, an obligation clearly violated by suicide. For example, suicide denies a society the labor provided by its members, or in the case of those with irreplaceable talents such as medicine, art, or political leadership, the crucial goods their talents enable them to provide. Another version states that suicide deprives society of whatever individuals might contribute to society morally (by way of charity, beneficence, moral example, etc.) Still, it is difficult to show that a society has a moral claim on its members' labor, talents, or virtue that compels its members to contribute to societal well-being no matter what. After all, individuals often fail to contribute as much as they might in terms of their labor or special talents without incurring moral blame. It does not therefore seem to be the case that individuals are morally required to benefit society in whatever way they are capable, regardless of the harms to themselves. Again, this line of argument appears to show only that suicide is sometimes wrong, namely, when the benefit (in terms of future harm not suffered) the individual avoids by dying is less than the benefits she would deny to society by dying.
A modification of this argument claims that suicide violates a person's duty of reciprocity to society. On this view, an individual and the society in which she lives stand in a reciprocal relationship such that in exchange for the goods the society has provided to the individual, the individual must continue to live in order to provide her society with the goods that relationship demands. Yet in envisioning the relationship between society and the individual as quasi-contractual in nature, the reciprocity argument reveals its principal flaw: The conditions of this "contract" may not be met, and once met, impose no further obligations upon the parties. If a society fails to fulfill its obligations under the contract, namely to provide individuals with the goods needed for a decent quality of life, then the individual is not morally required to live in order to reciprocate an arrangement that society has already reneged on.
As Baron d'Holbach wrote:
As Baron d'Holbach wrote:
If the covenant which unites man to society be considered, it will be obvious that every contract is conditional, must be reciprocal; that is to say, supposes mutual advantages between the contracting parties. The citizen cannot be bound to his country, to his associates, but by the bonds of happiness. Are these bonds cut asunder? He is restored to liberty. Society, or those who represent it, do they use him with harshness, do they treat him with injustice, do they render his existence painful?… Chagrin, remorse, melancholy, despair, have they disfigured to him the spectacle of the universe? In short, for whatever cause it may be, if he is not able to support his evils, let him quit a world which from thenceforth is for him only a frightful desert.
Moreover, once an individual has discharged her obligations under this societal contract, she no longer is under an obligation to continue her life. Hence, the aged or others who have already made substantial contributions to societal welfare would be morally permitted to commit suicide under this argument.
Suicide as a Moral Duty?
To this point, we have addressed arguments that concern whether a moral permission to engage in suicidal behavior exists, and indeed, it is this question that has dominated ethical discussion of suicide. Yet the social arguments against suicide are fundamentally consequentialist, and some act-utilitarians have discussed the correlative possibility that the good consequences of suicide might so outweigh its bad consequences as to render suicide admirable or even morally obligatory. In fact, in some cases, suicide may be honorable.
Suicides that are clearly other-regarding, aiming at protecting the lives or well-being of others, or at political protest, may fall into this category. Examples of this might include the grenade-jumping solider mentioned earlier, or the spy who takes his life in order not to be subjected to torture that will lead to his revealing vital military secrets. Utilitarians have given particular attention to the question of end-of-life euthanasia, suggesting that at the very least, those with painful terminal illnesses have a right to voluntary euthanasia. Yet utilitarian views hold that we have a moral duty to maximize happiness, from which it follows that when an act of suicide will produce more happiness than will remaining alive, then that suicide is not only morally permitted, but morally required.
Suicides that are clearly other-regarding, aiming at protecting the lives or well-being of others, or at political protest, may fall into this category. Examples of this might include the grenade-jumping solider mentioned earlier, or the spy who takes his life in order not to be subjected to torture that will lead to his revealing vital military secrets. Utilitarians have given particular attention to the question of end-of-life euthanasia, suggesting that at the very least, those with painful terminal illnesses have a right to voluntary euthanasia. Yet utilitarian views hold that we have a moral duty to maximize happiness, from which it follows that when an act of suicide will produce more happiness than will remaining alive, then that suicide is not only morally permitted, but morally required.
However, the thesis that there may exist a "duty to die" need not be defended by appeal to overtly consequentialist or utilitarian reasoning. In the course of articulating what he terms a "family-centered" approach to bioethics, the philosopher John Hardwig has argued that sometimes the burdens that a person imposes on others, particularly family members or loved ones, by continuing to live are sufficiently great that one may have a duty to die in order to relieve them of these burdens. Hardwig's argument thus seems to turn not on the overall balance of costs and benefits that result from a person living or dying, but on the fairness of the burdens that a person imposes on others by continuing to live.
While generally acknowledging Hardwig's suggestion that duties to others have been neglected in discussion of the ethics of suicide, critics of morally required suicide raise a number of objections to his proposal. Some doubt that the duty of beneficence to which Hardwig appeals justifies anything stronger than a permission to take one's own life when continuing to live is burdensome to others. Others worry that a moral requirement to commit suicide raises the sinister and totalitarian prospect that individuals may be obliged to commit suicide against their wishes. This worry may reflect an implicit acceptance of a variation of the sanctity of life view or may reflect concerns about infringements upon individual's autonomy. Other critics suggest even if there is a duty to die, this duty should not be understood as a duty that entails that others may compel those with such a duty to take their lives. Questions about social justice and equality (whether, for example, especially vulnerable populations such as women or the poor might be more likely to act on such a duty) are also raised. One utilitarian response to these objections is to reject a duty to die on utilitarian grounds: Suicide would be morally forbidden because general adherence to a rule prohibiting suicide would produce better overall consequences than would general adherence to a rule permitting suicide.
Autonomy, Rationality, and Responsibility
A more restricted version of the claim that we have a right to noninterference regarding suicide holds that suicide is permitted so long as — leaving aside questions of duties to others — it is rationally chosen, or to put it in a Kantian vernacular, if it is undertaken autonomously. This position is narrower than the libertarian view, in that it permits suicide only when performed on a rational basis and permits others to interfere when it is not performed on that basis.
This approach has given rise to a rich philosophical literature concerning the conditions for rational suicide. For the most part, this literature divides the conditions for rational suicide into cognitive conditions, conditions ensuring that individuals' appraisals of their situation are rational and well-informed, and interest conditions, conditions ensuring that suicide in fact accords with individuals' considered interests. Richard Brandt captures the spirit of this approach:
The person who is contemplating suicide is obviously making a choice between future world-courses: the world-course that includes his demise, say, an hour from now, and several possible ones that contain his demise at a later point… The basic question a person must answer in order to determine which world-course is best or rational for him to choose, is which he would choose under conditions of optimal use of information, when all of his desires are taken into account. It is not just a question of what we prefer now, with some clarification of all the possibilities being considered. Our preferences change, and the preferences of tomorrow are just as legitimately taken into account in deciding what to do now as the preferences of today.
Other examples of this approach include Glenn Graber, who states that a suicide is rationally justified "if a reasonable appraisal of the situation reveals that one is better off dead." An appraisal is reasonable, according to Graber, if one judges rationally about the likelihood of her present and probable future values and preferences being satisfied. On Graber's view, a suicide is rational if it results from a clearheaded assessment of how suicide would further or impede one's overall interests. Margaret Battin identifies three cognitive conditions for rational suicide (a facility for causal and inferential reasoning, possession of a realistic world view, and adequacy of information relevant to one's decision), along with two interest conditions (that dying enables one to avoid future harms, and that dying accords with one's most fundamental interests and commitments).
For the most part, suicidal individuals do not manifest signs of systemic irrationality, much the less the signs of legally definable insanity, and with the exception of severe psychopaths, engage in suicidal conduct voluntarily. However, these facts are consistent with the choice to engage in suicidal behavior being irrational, and serious questions can be raised about just how often the conditions for rational suicide are met in actual cases of self-inflicted death. Indeed, the possibility of rational suicide requires that certain assumptions about suicidal individuals' rational autonomy be true which may not be in many cases. A person's choice to undertake suicidal behavior may not be a reflection of her true self and her self-inflicted death could be an act that she would, in calmer and clearer moments, recoil at. In other words, even if there is a right to self-determination which in turn implies a right to suicide, it seems to imply a right to commit suicide only when one's true self is making that determination, and there are numerous factors that may compromise a person's rational autonomy and hence make the decision to engage in suicidal behavior not a reflection of one's considered values or aims. Some of these factors cognitively distort agents' deliberation about whether to commit suicide. The act of suicide is often impulsive and poorly thought out, reflecting the intense psychological vulnerability of suicidal persons and their proclivity toward volatility and agitation. Suicidal persons can also have difficulty fully acknowledging the finality of their death, believing that (assuming there is no afterlife) they will continue to be subjects of conscious experience after they die. In what are known as dyadic suicides, the suicidal individual actually looks forward to the moment when she will (posthumously) enjoy having insulted or having exacted revenge upon another person.
Particularly worrisome is the evident link between suicidal thoughts and mental illnesses such as depression. While disagreement continues about the strength of this link little doubt exists that the presence of depression or other mood disorders greatly increases the likelihood of suicidal behavior. Some studies of suicide indicate that over 90% of suicidal persons displayed symptoms of depression before death, while others estimate that suicide is at least 20 times more common among those with clinical depression than in the general population. In cases of suicide linked with depression, individuals' attitudes toward their own death are colored by strongly negative and occasionally distorted beliefs about their life situations (career prospects, relationships, etc.). As Brandt observed, depression can "primitivize one's intellectual processes," leading to poor estimation of probabilities and an irrational focus on present suffering rather than on possible good future states of affairs.
The suicidally depressed also exhibit romanticized and grandiose beliefs about the likely effects of their deaths (delusions of martyrdom, revenge, etc.) Furthermore, suicidal persons are often hesitant about their own actions, hoping that others will intervene and signaling to others the hope that they will intervene. Finally, although repeated suicide attempts by the same individual are common, the impulse to suicidal behavior is often transient and dissipates of its own accord. Taken together, these considerations indicate that, even if there is a right of self-determination, the scope of suicidal conduct that genuinely manifests fully informed and rational self-evaluation may be rare and so only occasionally will suicide be rational or morally permissible, even when excusable because irrational. (Philip Devine has even argued that suicide is necessarily irrational: Because no one has experience of death, a suicidal individual lacks the knowledge needed to judge continued life with its alternative. Moreover, if suicide is frequently not an expression of individuals' rational self-determination about their well-being, that suggests that others may have a prima facie reason to interfere with suicidal behavior and so is there is no general right to noninterference.
The suicidally depressed also exhibit romanticized and grandiose beliefs about the likely effects of their deaths (delusions of martyrdom, revenge, etc.) Furthermore, suicidal persons are often hesitant about their own actions, hoping that others will intervene and signaling to others the hope that they will intervene. Finally, although repeated suicide attempts by the same individual are common, the impulse to suicidal behavior is often transient and dissipates of its own accord. Taken together, these considerations indicate that, even if there is a right of self-determination, the scope of suicidal conduct that genuinely manifests fully informed and rational self-evaluation may be rare and so only occasionally will suicide be rational or morally permissible, even when excusable because irrational. (Philip Devine has even argued that suicide is necessarily irrational: Because no one has experience of death, a suicidal individual lacks the knowledge needed to judge continued life with its alternative. Moreover, if suicide is frequently not an expression of individuals' rational self-determination about their well-being, that suggests that others may have a prima facie reason to interfere with suicidal behavior and so is there is no general right to noninterference.
Duties Toward the Suicidal
With the exception of the libertarian position that each person has a right against others that they not interfere with her suicidal intentions, each of the moral positions on suicide we have addressed so far would appear to justify others intervening in suicidal plans, at least on some occasions. Little justification is necessary for actions that aim to prevent another's suicide but are non-coercive. Pleading with a suicidal individual, trying to convince her of the value of continued life, recommending counseling, etc. are morally unproblematic, since they do not interfere with the individual's conduct or plans except by engaging her rational capacities. The more challenging moral question is whether more coercive measures such as physical restraint, medication, deception, or institutionalization are ever justified to prevent suicide and when. In short, the question of suicide intervention is a question of how to justify paternalistic interference.
As mentioned earlier, the impulse toward suicide is often short-lived, ambivalent, and influenced by mental illnesses such as depression. While these facts together do not appear to justify intervening in others' suicidal intentions, they are indicators that the suicide may be undertaken with less than full rationality. Yet given the added fact that death is irreversible, when these factors are present, they justify intervention in others' suicidal plans on the grounds that suicide is not in the individual's interests as they would rationally conceive those interests. We might call this the ‘no regrets' or ‘err on the side of life’ approach to suicide intervention. Since most situations in which another person intends to kill herself will be ones where we are unsure of whether she is rationally choosing to die, it is better to temporarily prevent "an informed person who is in control of himself from committing suicide" than to do "nothing while, say, a confused person kills himself, especially since, in all likelihood, the would-be suicide could make another attempt if this one were prevented and since the suicidal option is irreversible if successful." Further psychiatric or medical examinations may settle the matter regarding the rationality of the suicidal individual's decision. The coerciveness of the measures used should be proportional to the apparent seriousness of the suicidal person's intention to die.
A neglected aspect of our duties toward the suicidal is the possibility that we may have a moral duty to aid others to commit suicide. (This possibility is directly related to physician-assisted suicide and the larger question of whether the right to suicide is a claim right.) If there are circumstances that justify our intervening to prevent suicide undertaken irrationally or contrary to a person's self-interest, then the same paternalistic rationale would justify our helping to promote or enable those suicides that are rational and in accordance with a person's self-interest. The widespread moral acceptance of aiding others to commit suicide may portend substantial moral perils, as it opens up the possibility that assisted suicide could be vulnerable to various forms of abuse, manipulation, or undue pressure that make an otherwise irrational suicide rational. For example, the family members and health care providers of a terminally ill patient might grow weary of the financial or personal burdens of caring for such a patient and decide to provide substandard palliatve care in order to make suicide more attractive to that patient. Hence, by giving license for others to assist in suicides, we may unwittingly permit them to encourage suicides not because those suicides are in fact in the best interests of the individual in question, but because those suicides advance the interests of other people or of institutions. Indeed, a good deal of the apprehension surrounding physician-assisted suicide arise from worries about whether laws and institutional practices can be formulated that both permit others to aid in rational suicide while also preventing abuses and manipulation.
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