Should I finance your suicide?

Dear Dr. brilliant Cliché

I work for an insurance company and my job is to approve the allocation of funds for costly procedures. This came across my desk today and although I had to approve it, it just gets my gourd. The applicant was a male in his mid fifties who’d had two previous serious suicide attempts. I was being asked to authorize funds for a $100,000 cardiac procedure scheduled for later this same week. The procedure was unrelated to his suicide attempts and he had already consented to this life extending procedure. If he refused to have the procedure, he would not immediately die but would so in the near future.
What I can’t wrap my head around is this: there are limited health care resources. This man is on state funded insurance. He is essentially asking people to extend his life, but he has deliberately tried to end that life twice already. Statistically if the operation is a success and he lives he will, in the near future, try to kill himself again.
Is it ethical to save this man’s life if he values it so little? Why is he even consenting to this operation if he wants to die? Why wouldn’t he just refuse and let nature take its course?

Baffled

Dear Baffled,

People who have concrete perceptual ability and think in black and white can run two very different thought streams at the same time and not see how one relates to the other. In one thought stream this man wants to die. In the other he was just sold a health care procedure by his doctor. Medicine as practiced in the USA today is very product centered. A procedure or treatment is a product and as such would be explained to this man much the same as buying a new car. Of course he wants the new car, even if he plans never to use it. It might not ever occur to him that if he just said no he would get his wish and no one could stop him. Of course he might also be ambivalent about wanting to die despite his two previous suicide attempts. He might even be hoping the surgeon kills him.

Is it ethical to do the procedure and to use public money for it, given his suicidal bent? According to our prevailing culture it is not only ethical but by law you are unable to withhold medical procedure due to mental illness. You could even argue that his mental illness would impair his capacity to refuse a life saving medical procedure. He theoretically then could be forced to have it despite his desires. Note that no one will most likely question his capacity to consent if he elects to have the procedure.

Dr. Brilliant Cliché

Granny says: There’s another factor neither of you seem to be considering. Just as there are medications that can produce suicidal thoughts, there are medical conditions that can produce suicidal thoughts. Chronic pain and fatigue can certainly make one wish to just go to sleep and end it all. Perhaps this procedure can correct a condition that is making this man so miserable and he won’t want to kill himself anymore.
That being said, I think we spend entirely too much money keeping people alive who perhaps shouldn’t be. Sunny Von Bulow certainly comes to mind. If the over-population of the earth is the largest contributing factor to it’s eminent demise, we might want to rethink that “life at any cost” attitude we’ve been patting ourselves on the back for.

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About Dr. Brilliant Cliché

Dr. Brilliant Cliché and the Granny Dr. are a fictional web presence and advice blog. Together we offer a joint perspective that is deep but not academic, entertaining but not fluff, and educated yet street smart. By joining the internet community we hope to share thoughts and stimulate insightful conversation around pressing issues that affect us all. Looking forward to hearing your thoughts. (This is not a site for therapy nor does it intend to replace medical or other professional care. ) You can leave comments here or email The Dr. at dr.brilliantcliche@yahoo.com and don’t forget to like us on facebook. Our facebook page is Dr. Brilliant Cliche
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3 Responses to Should I finance your suicide?

  1. S.H. – writes in:

    Interesting question here. Also, interesting feedback. I sense the responses are all coming from a more intellectual in one’s head concept, and though not bad responses, when I read this question, I could not help but feel deep compassion for this man who is suffering in many ways, and felt it was off putting that once again, a human life was being questioned by dollar signs. It turned my stomach, literally to view a human being in such a cold, detached way that is being debated only by is this person entitled to public health insurance approval and reimbursement for a needed life saving operation. I have known people denied proper medical care and have died, or nearly died due to refusal of medical help and insurance. It happens all the time. I am a victim of refusal of proper public medical insurance coverage contributing to my serious, complex, auto-immune condition triggered by Lyme Disease. I was refused proper treatment and testing for 3 years and by then it was too late. If a person is suffering for whatever reasons that they attempt suicide, it truly is a shame. In my opinion it does not really matter if one has attempted suicide, or how many times, or if one has suicidal ideation, or what the statistics are. I had a 1% chance to put my Lyme into full or partial remission. I fought to stay out of a wheel chair. Graduate school and working as a mental health professional were not part of the statistics or predictions for me. But due to public funding, I have been able to move forward and have opportunities I could not have afforded without government funding for medical or rehabilitation. IT should not matter and a person should be treated with respect, kindness, and compassion, as well as an opportunity to begin anew, as I was given and so grateful for. I have worked with many people that wanted to die, made attempts, and with intensive therapy, they did start to stabilize and actually want to live and so grateful for that opportunity. There are many reasons for severe depression, from poor quality to life, poverty, serious chronic illness, chemical imbalances, wrong medications, wrong view and perceptions, or due to lack of purpose and meaning and spiritual connection to something bigger than ourselves…… Compassion and beginning anew, practicing non-judgment, equanimity is so important in the therapeutic healing process!

  2. Ken Bryant says:

    It seems there are widely different issues which may influence this decision. There is our universal/emotional attachment we often possess for each other’s lives. We want to do whatever we can to protect the value of life, even when there seems to be valid arguments to deny this to some individuals. Otherwise suicide could be viewed as a natural form of population control. Why be a Samaritan? Why get involved?
    Insurance statistics on repeated attempts at suicide as predictors of future attempts may not be all that valid. After all, the “privileged” can opt out of national health care and probably get better preventative and proactive treatment for a variety of conditions. How can we whine about taxpayer money spent on someone who couldn’t get access to the best treatment options?
    Let the man have his procedure. If its suicide we’re worried about, its more life-threatening to be by yourself when reading about government waste!

  3. Dear Ken,
    “If its suicide we’re worried about, its more life-threatening to be by yourself when reading about government waste!” -FUNNY but sadly to true. Excellent points as always..

    Dr. B.C.

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