Duquesne Law Review Volume 24 Number 1 Article 3 1985 Suicide: A Constitutional Right? Thomas J. Marzen Mary K. O'Dowd Daniel Crone Thomas J. Balch Follow this and additional works at: https://dsc.duq.edu/dlr Part of the Law Commons Recommended Citation Thomas J. Marzen, Mary K. O'Dowd, Daniel Crone & Thomas J. Balch, Suicide: A Constitutional Right?, 24 Duq. L. Rev. 1 (1985). Available at: https://dsc.duq.edu/dlr/vol24/iss1/3 This Article is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Duquesne Law Review by an authorized editor of Duquesne Scholarship Collection. Duquesne Law Review Volume 24, Fall 1985, Number 1 Article Suicide: A Constitutional Right? Thomas J. Marzen Mary K. O'Dowd Daniel Crone Thomas J. Balch* TABLE OF CONTENTS I. INTRODUCTION .................................... 3 II. CONTEMPORARY ADVOCACY OF SUICIDE ............... 4 III. THE ISSUE: A CONSTITUTIONAL RIGHT TO SUICIDE .... 8 A. Acts Versus Omissions ....................... 9 B. Is There A Constitutional Right to Autonomy? 13 C. The Basis of the Right to Privacy ............ 14 * Marzen: B.A., University of Illinois; J.D., Illinois Institute of Technology, Chicago- Kent College of Law; General Counsel, National Legal Center for the Medically Dependent and Disabled. O'Dowd: B.S.; M.D. candidate, Northwestern University; Medical Consultant, Americans United for Life Legal Defense Fund. Crone: B.A., Ph.D. candidate in Philosophy, Loyola University-Chicago. Balch: B.A., Williams College; J.D., New York University; Staff Counsel, National Legal Center for the Medically Dependent and Disabled. The authors gratefully acknowledge the research assistance and writing assistance of Richard Coleson and Joel Tornari and the research assistance of Frank Melone, Keith Moore, Mary Anne Naso, Cathleen Perry, William Short, John F. Stucky, and Mary Anne Xanios-Murphy. Duquesne Law Review Vol. 24:1 IV. HISTORICAL ATTITUDES TOWARD SUICIDE ............ 17 A. Ancient Judaic Culture ...................... 17 B. Ancient Greco-Roman Culture ................ 20 C. Early Christian Culture ..................... 26 D. The M iddle Ages ............................ 29 E. The Renaissance and Reformation ............ 31 F. The "Age of Reason" and Beyond ............ 33 G. Seventeenth and Eighteenth Century Political Philosophers and the American Founders ..... 40 H. Contemporary Religious Viewpoints ........... 50 V. ENGLISH COMMON LAW ........................... 56 VI. THE UNITED STATES .............................. 63 VII. OTHER JURISPRUDENTIAL CONSIDERATIONS ........... 100 A. The Scope of a Constitutional "Right to Sui- cide" .... ............... ............. ...... 100 B. "Rational Suicide: A Limitation of the Scope of the R ight? .................................. 105 C. The Scientific Literature .................... 107 D. Ambivalence and Reversibility ................ 108 E. Mental Disorder in Suicidal Individuals ...... 111 1. Depressive Disorders and Suicide ......... 112 2. Cognitive Disturbance in Depressive Disor- der ........ .................... ......... 116 3. Psychodynamic Explanations: Freud and Menninger ............. ... 120 F. Suicide Attempts: Is Death Always the Goal?.. 122 G. Socioeconomic Pressures that Induce Suicide .. 127 H. Internal Dynamics the Induce Suicide ........ 131 1. Physical Illness .......................... 131 2. G rief ................................... 133 3. Prejudice and Oppression ................ 134 4. Teenage Stress .......................... 136 I. The Effect on Others: Suicide Epidemics and M ass Suicide .................. ............. 139 V III. C ONCLUSION ..................................... 146 IX. APPENDIX: THE LAWS OF THE UNITED STATES ........ 148 1985 Suicide 3 I. INTRODUCTION It is estimated that over 25,000 people now commit suicide in the United States each year, and that over 200,000 attempt it.1 The total number of reported suicides in this country has in- creased slightly since 19702 with the annual rate averaging twelve suicides per population of 100,000. 3 The highest rate of suicide, by far, is among white males who are eighty-five years of age or older. In comparison with other groups in this age category, suicides among white males occur about three times more often than among non-white males, ten times more often than among white females, and twenty times more often than among non-white females." Since 1970, the rate of suicide for those between the ages of fif- teen and twenty-four has increased dramatically;5 suicide is now the third leading cause of death for persons during those youthful years.' The suicide rate among those between twenty-five and thirty-four years of age and among those eighty-five or older has increased marginally, 7 while the rate has either slightly declined or 1. M. Ahmed, Suicide and Attempted Suicide, 75 OHIO ST. MED. J. 73, 73 (1979). 2. From 23,480 in 1970 to 29,480 in 1983, a 23.9% increase. See generally U.S. NA- TIONAL CENTER FOR HEALTH STATISTICS, U.S. DEP'T OF HEALTH, EDUCATION AND WELFARE, VITAL STATISTICS OF THE UNITED STATES (1970-1979) [hereinafter cited as VITAL STATISTICS]; PUBLIC HEALTH SERVICE, U.S. DEP'T OF HEALTH AND HUMAN SERVICES, UNITED STATES PUB. No. 84-1232 (1984) (including years 1980-present) [hereinafter cited as PUBLIC HEALTH SERVICE]. 3. In 1970, the rate was 11.8 suicides per population of 100,000. The reported rates in succeeding years were as follows: 1971 (11.7); 1972 (12.0); 1973 (12.0); 1974 (12.1); 1975 (12.7); 1976 (12.5); 1977 (13.3); 1978 (12.5); 1979 (12.4); 1980 (11.9); 1981 (11.3); 1982 (12.4). The average rate of suicide over these twelve reported years was 12.2 suicides per average population of 100,000. VITAL STATISTICS, supra note 2 (cited and calculated from annual figures 1971-79); PUBLIC HEALTH SERVICE, supra note 2 (cited and calculated from annual figures 1980-82). 4. The average rates of suicide by age group for the eleven year period from 1970 to 1980 are as follows: 15-24 years 25-34 years 45-54 years 65-74 years 85+ years White Males 18.5 23.4 27.4 36.2 50.7 Non-White Males 14.1 22.5 12.7 12.6 13.8 White Females 4.8 8.6 13.1 8.9 5.0 Non-White Females 4.0 5.9 4.1 2.7 2.4 VITAL STATISTICS, supra note 2 (cited and calculated from annual figures 1970-79); PUBLIC HEALTH SERVICE, supra note 2 (cited and calculated from 1980 annual figures). 5. In 1970, the rate of suicide per population of 100,000 in the 15-24 age category was 8.8. VITAL STATISTICS, supra note 2 (1970). In 1980, the rate of suicide in the same age category was 12.3, an increase of forty percent. PUBLIC HEALTH SERVICE, supra note 2 (1980). 6. NATIONAL CENTER FOR HEALTH STATISTICS, PUB. No. 10, 32 MONTHLY VITAL STATIS- TICS REPORT, (Supp.2, Feb. 17, 1984). 7. The rate of suicide per population of 100,000 in the 25-34 age category in 1970 was Duquesne Law Review Vol. 24:1 remained constant in all other age categories.' As one eminent psychologist recently noted: Suicidal risk is considerably high in single, elderly, and white males; in cases of depression, chronic disabling illnesses, recent childbirth, and surgery; in persons who are unemployed, facing financial difficulties; and in persons liv- ing alone with a history of recent loss of family member, job or prestige. Incidence of suicide is high among alcoholics. Also included in high risk groups are young people ... whose suicidal attempt is diagnosed as a sui- cidal gesture or a nonserious attempt and who are discharged without ade- quate treatment, family involvement, or follow-up.9 Thus, the ranks of those who attempt suicide are disproportion- ately filled with marginal members of our society-the aged, the poor, the ill or disabled-and with those who are isolated and lack- ing in personal and social support-the single or recently bereaved, the alienated and unhelped young. II. CONTEMPORARY ADVOCACY OF SUICIDE It is in this context that a social movement has arisen, supported by a number of philosophers and legal commentators, that regards suicide10 as neither tragic nor wrong, but as a basic human right. In the United States, the Hemlock Society has published a manual 14.1. For the same year, the rate of suicide in the 85 years or older category was 19.0. VITAL STATISTICS, supra note 2 (1970). In 1980, the rate of suicide per population of 100,000 people in the 25-34 age category was 16.0. For the same year, the rate of suicide in the 85 years or older category was 19.2. PUBLIC HEALTH SERVICE, supra note 2 (1980). The average suicide rate in 1970 was 11.6; it was 11.9 in 1980. Id. 8. The average rates of suicide for all other age categories in 1970 and 1980 are as follows: 1-14 years 35-44 years 45-54 years 55-64 years 65-74 years 75-84 years 1970 0.3 16.9 20.0 21.4 20.8 21.2 1980 0.4 15.4 15.9 15.9 16.9 19.1 9. M. Ahmed, supra note 1, at 75. 10. WEBSTER'S THIRD NEw INTERNATIONAL DICTIONARY OF THE ENGLISH LANGUAGE 2286 (3d ed. 1969) defines suicide as "the act or an instance of taking one's own life voluntarily and intentionally: self-destruction ... [;] the deliberate and intentional destruction of his own life by a person of years of discretion and of sound mind: felo-de-se." BALLENTINE'S LAW DICTIONARY 1236 (3d ed. 1969) defines it as "Death by one's own hand intentionally lifted against himself." BLACK'S LAW DICTIONARY 1286 (rev. 5th ed. 1979) defines it as "Self-de- struction; the deliberate termination of one's existence." Some advocates of suicide prefer to avoid the term. "Euthanasists are repulsed by the label of 'suicide' in lieu of voluntary ac- tive euthanasia, since suicide is correlated with irrational behavior. The term 'self-deliver- ance' is a more accurate description of the act." D.