Posted by: Witch Doctor | October 19, 2009

Suicide, Capacity, Self-determination, Paternalism, Persuasion

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It could be argued that when an individual grabs a gun and shoots himself (usually himself) then the intention was to commit suicide.

It could be argued that when an individual hangs himself or herself by the neck, then the intention was to commit suicide.

When the deeds are done, these people are usually not in a position to withhold consent for treatment. They have chosen a Fast Death. This is much easier than a Slow Death where onlookers have the opportunity to debate whether the conscious individual really means what they say they mean, followed by another debate on whether it is legally or morally correct to try to save a life, taking into account the right of self determination.

This decision-making lack of decision-making must be painful for those watching The Slow Death.

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The Law in England assumes that capacity is present until proven otherwise, that a depressed person is not necessarily lacking in capacity, and that the right to self-determination in the individual who has capacity is paramount.

So, in England, if you see a conscious person pointing a loaded gun to their head with their finger on the trigger, the default position is that they have capacity and since they are also holding the trump card of self-determination in one hand and a gun in the other, then let them shoot.

Keep it simple.

Keep within the law.

Let them shoot!

As long as you can be sure that they are only going to shoot themselves of course.

So maybe that’s a bit of a conundrum.

Not a good example.

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Anyway, ignoring the conundrum, the paternalistic ones of the human race may shout, “Don’t shoot! Come and talk with me and I will help you!”

i.e. you will intervene to try to change that person’s will using the technique of persuasion.

Paternalism, although not yet illegal, is frowned upon in England.

Father figures are not welcome.

However, persuasion is OK. Think of the adverts on billboards and everywhere you look. Think junk mail.  Think sales talk. Think alternative medicine. Think bottled water……

Persuasion is hallowed in England.

It has to be.

We have a nation of people employed one way or another in the tactics of persuasion.

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So don’t call your intervention “Paternalism.” Call it “Persuasion.”

For goodness sake!

Here is another example with less of a conundrum.

In England, if you see a young woman with a noose around her neck and she is about to jump down into a stairwell, then if you are paternalistic, by all means shout a fatherly “Don’t jump!” You could even talk in a gentle hypnotic voice to her as you climb the stair to be beside her.

Remember, you might be criticised because you are intervening with her right to self-determination, but in England it is still within the law to be paternalistic.

Paternalism is bad, though. Very bad. But at the moment you can safely assume you won’t go to jail for it. But you can conceal the fact you are using paternalism by calling it persuasion. Then you won’t be an outcast.

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The law, however, seems to be on your side if you just stand by and watch.

But don’t shout, “Go on – Jump.”

Because then you would be aiding and abetting.

Mark you, if you shouted very loudly “don’t jump” then that might give her a terrible fright and she might lose her balance.

Maybe somebody would then accuse you of aiding and abetting.

No.  The intention was to prevent rather than facilitate.

But who can prove that?

Perhaps you just chose your aiding and abetting words carefully. It was the volume you used to shout them that had the desired effect of suicide facilitation.

Aiding and abetting in the context of suicide is bad. It is illegal and carries with it a prison sentence.

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Watching and allowing is good.

Three words: “Go on – Jump” make you a criminal.

Two words “Don’t jump” might make you criminal too, but you probably won’t get caught because everyone will believe the words, not the scary way you used the words.

But the outcome for the individual with the noose around her neck is the same.

Death.

In suicide, The Outcome is not important.

But The Pathway is.

So they say………

By doing nothing you have acknowledged the prime and noble positions legally and morally of “capacity by default” and “self-determination” in a conscious patient.

You have not aided and abetted.

But you have allowed.

This play upon words means that at night you can sleep the sleep of the righteous with The Book of Law under your pillow.

While you cuddle into your pacifier blanket enchantingly embroidered with the nursery rhyme called :  “The Alternative Moral Code of the State”

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