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Suicide on prescription?

My Master’s thesis on physician-assisted suicide, its ethical permissibility and its implications can be found here. The thesis is written in German, however, to give you a brief introduction to my work, I invite you to read the following English abstract.

Abstract

Illness and suffering are an intrinsic part of life for many people, but dying and death is an immanent part of life for everyone. This, in connection with the constant advances in biotechnology and medical technology, makes the call for answers, especially to end-of-life questions, ever louder. For example, in relation to the desire to take one’s own life with medical help, because it has become unbearable due to illnesses that can no longer be endured. For many of those affected, living in dignity is subjectively no longer possible and there is no longer even the prospect of dying with dignity without assisted suicide. Among the disciplines of law, medicine, ethics, etc., there exists a pluralism of views and arguments on physician-assisted suicide, resulting in what appears to be an ongoing controversy and suffers a lack of clear guidance. This thesis hence focuses on the question of whether – and if so, under what conditions – physician-assisted suicide can be assessed as permissible from an ethical point of view and as a morally good action. A list of admissibility criteria was developed using relevant literature and taking into account own considerations. These criteria are to be understood as a foundation of rules for dealing with suicidal wishes with the help of medical assistance, namely to the extent that only if they are fulfilled can assisted suicide by a physician be considered ethically permissible at all. Based on the considerations, criteria emerged (A) on the social and socio-political level, (B) on the part of the person willing to die, (C) on the part of the assisting doctors and (D) those that apply equally to physicians and patients. However, this set of rules is merely recommended as a possible ethical orientation aid in combination with a conscious, sensitive and situation-specific approach.

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It takes many villages…

In my last post, I discussed societal issues related to self-worth and the sense of being enough. I explored what matters in our society and our lived reality, and how the dynamics of self-worth seem to be closely tied to the values and goals pursued by Western societies in particular.

I concluded by posing a list of questions that arose for me on this topic. My aim was to stimulate reflection and awareness, and encourage discourse and collective commitment to addressing the issues as well as promoting change. But that wasn’t all I was promoting. While the feedback I received was generally in line with what I meant to achieve, I was surprised to find that my partner, of all people, was the one who got upset.

What made him angry was that he wanted answers, not just questions. Although, as I would put it, the work of a philosopher involves raising questions, thinking critically, reflecting, engaging with different approaches, and encouraging others to do the same—something I consider a form of service—he felt that I already knew the answers, or at least some of them. He believed I was holding them back and wanted me to share them. I heard him. So, here we are—let’s give it a try, in the service of a good life!

Well, the first and most important step to changing the way things are – and that was indeed the aim of my last post – is to become aware and mindful. This means taking an honest, vulnerable and critical look at the current state of things. We must not look away, numb ourselves, run away, or sugarcoat things. Instead, we need a clear and honest assessment of what is there. I believe that awareness, combined with self-honesty, is the first step towards change.

But it is not enough to simply become aware of what is going wrong and needs to be changed. We also need to cultivate, or rather unlock, an inner guidance system that identifies what is good for oneself, for others, the world and what is in it – for the greater or collective good.

Secondly, just as important as the subjective aspect is the objective one: working together and striving for the collective good. While many people lead conscious lives and seek alignment and authenticity, they often encounter systemic limitations that prevent them from fully realizing their potential. These individuals may struggle to effectively use their inner guidance system due to factors such as work environments, politics, socio-political circumstances, and societal values and goals—elements that society has implicitly agreed upon regarding how things should function, a long time ago.

And don’t get me wrong; I understand that everyone’s definition of “good” or what constitutes a good life is not identical. My inner guidance system may consider something different as good for me than yours does for you. The search for a consensus on what makes a good life is an ancient and ongoing quest. For instance, Aristotle, in his Nicomachean Ethics, argues that the good life is achieved through eudaimonia, or flourishing. This involves living in accordance with reason and virtue, practicing moral and intellectual virtues, finding a balance between extremes, and cultivating meaningful friendships. For example, a person living according to Aristotle’s approach might strive to balance a demanding career with quality time spent with family, engage in continuous learning through reading and educational activities, and nurture deep, supportive relationships with friends. By making thoughtful decisions, avoiding excesses, and fostering both personal and professional growth, such a person reflects Aristotle’s concept of eudaimonia.

In the Letter to Menoeceus and the Principal Doctrines, Epicurus argues that the good life is achieved through the pursuit of simple pleasures and the avoidance of pain, with a focus on tranquillity (ataraxia) and, like Aristotle, meaningful friendships. He advocates for a life of moderation and intellectual enjoyment rather than physical indulgence. For example, someone following Epicurus might find contentment through quiet moments with close friends, engaging in reflective conversations, and enjoying simple, daily pleasures like a leisurely walk or a home-cooked meal. Similarly, John Stuart Mill, a proponent of utilitarianism and author of Utilitarianism, argued that the good life is one that maximizes overall happiness or pleasure. He distinguished between higher and lower pleasures, asserting that intellectual and moral pleasures are superior to mere physical ones. For instance, a person living according to Mill’s philosophy might prioritize activities such as pursuing advanced education, contributing to charitable causes, and engaging in thoughtful discussions, valuing these enriching experiences over temporary physical pleasures.

Although our understanding of what constitutes a good life may differ, I believe we can all agree that meeting our needs and working towards a good life for everyone is important. We need to genuinely acknowledge that what’s good for me, the needs of others, and the well-being of the planet all matter. Recognizing and committing to the fact that these needs are interconnected and that meaningful change requires addressing them on a large scale is a crucial step.

Further we need to live as authentically and consciously as possible, aligning with our true selves and our needs. By doing so, we can serve as role models and beacons for others, inspiring them to unlock their own guidance systems and find alignment. This example in turn helps our children and following generations learn how to navigate their emotions, needs, develop self-love, build confidence, and grow into empathetic, conscious, and authentic adults who feel worthy and enough.

Also, learning should not be framed as a competition, nor should our knowledge be used to define our worth. Schools should not merely emphasize scientific knowledge or enforce conformity through comparison. Instead, education must celebrate and embrace each student’s uniqueness, nurturing their individual interests and potential. Schools should empower and help children to understand the world, life, and themselves by creating dynamic spaces for curiosity, self-expression, exploration, and deep questioning.

We need to slow down, reflect, rethink, and rebuild. We should define the good life as both our individual and collective goal and work towards it. It’s crucial to stop allowing a handful of powerful figures—whether executives, lobbyists, politicians, or others—to dictate what matters based solely on capital, money, profit, or personal interests. This shift must be enforced through systemic changes and collective action to ensure that decision-making aligns with the broader good. What truly matters is all of us striving to make life the best experience possible. To achieve this, we must recognize that our well-being, the well-being of others, and the health of this beautiful and wondrous planet are deeply interconnected. Embracing this interconnectedness and striving for balance and alignment is essential. Only then can we truly thrive!

With this in mind, I’ll close by asserting that, from my perspective, the saying “it takes a village” has evolved to reflect a deeper truth: it takes many villages—and every single one of us—to bring about the changes we want to see in the world.

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“Not enough” or is it?

Think back to when you were a child, about six or seven years old. How you try to make sense of the world, how you sit at school and learn about this and that – hopefully something that does help you to make sense of it (the world that is). And then a few years further on, when you were eleven or twelve or even thirteen years old, when on top of that you start to feel about yourself and others differently and try to find your own voice in all the chatter around you. And then a teacher hands you a piece of paper that says “not enough”.

How does that make you feel? What does it mean for you to read this, to be judged as “not enough”?

Firstly, that would be inappropriate for a teacher, right? Secondly, your parents would probably have been outraged and thirdly, of course nobody would do something like that. Or would they?

A few days ago, when I was in that waking state where the brain somehow wanders of its own accord and deep thought sets in effortlessly, the Austrian grading system came to mind. It consists of the numbers 1 to 5 and for each number there is a meaning: 1 means “sehr gut”, which corresponds to “very good”, 2 means “gut” or “good”, 3 means “befriedigend”, which can be translated as “satisfactory”, 4 means “genügend” or “enough” and 5 means “nicht genügend”, which can be translated as “not enough”. This system starts from the age of 6 and applies until graduation from university. It was at that moment that I realized: not only are our effort, intelligence and talent – translated into “performance” – evaluated and graded in this way from a young age, there is also a grade that actually means “not enough”, that you are somehow not enough, and that is when you fail.

I started thinking about the many people who struggle with their self-worth, who feel inadequate in most areas of their lives, who don’t feel worthy of x, y or z, who suffer from imposter syndrome and who don’t feel enough. What has happened to all these people?

Theories about self-worth are varied and differ greatly from one another. While there are theories and thinkers such as psychologist Nathaniel Branden who completely separate the sense of self-worth from other people and their opinion of us or their view of us, there are also theories that claim that a person’s self-worth can serve as an indicator of how others see and value them and the nature of their relationships (see, for example, M. R. Leary and colleagues).

Well, ideally, self-worth is not at all dependent or even influenced by what others think, feel, say, etc. about one, because then, intuitively speaking, self-worth would be something only you ascribe to yourself, it would be unshakeable and entirely untouchable by any external influence. No achievement, no knowledge, no accomplishment would be necessary to feel worthy and enough. Doesn’t that sound great? And although this can be achieved through things like extensive self-reflection, letting go of old beliefs and conditioning, working on one’s Self, self-love and by giving zero about how others view ourselves and what society expects, it seems that self-worth in our lived reality is very much influenced by conditions that lie outside the Self. Why is this the case? No one is born feeling inadequate, are they? However, making our worth independent of external conditions is not exactly something we teach or learn in our society.

Rather, it seems that we learn very early on to compare ourselves with others or to compare our performance with that of others. We learn that what we do and how we do it determines our value. We learn that we will be judged for almost everything we do or what we stand for, but not how to deal with that judgment. And this begins at the age when we as humans are most susceptible to influence, when our self-image and worldview are shaped – precisely when it is most consequential for ourselves and our way of life.

So, I ask again: Where do all these anxious and struggling people come from? And why are things the way they are? Is it possible that society isn’t even interested in changing? Perhaps because people who need to perform in order to feel worthy, enough and accepted are more inclined to overachieve, appease and keep the economy going out of fear of devaluation and failure?

And while there are certainly other reasons that make people feel inadequate, and while professional feedback about a child’s or student’s learning and development can be useful and important, I want us to think about how can we change the way things are? How can we teach and support children to develop into self-loving, confident and empathetic adults who feel worthy and enough while having fun learning? How can we stop the constant comparing, pressure to perform and succeed and move to an authentic and intentional way of living? How can we thrive more and be less driven?

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Have we created a monster?

Life as we humans have created it over thousands of years and live in most parts of this world has something antibiotic, i.e. against life, about it. What is meant by this? If we think about how much time we spend doing gainful work to earn our living (one could also think about this designation), it seems that nowadays we do not work to live, but rather live to work, and the trend is increasing.

There is such a great imbalance in this world as well as in our individual lives that, intuitively, cannot be natural. On the one hand, there are many people who have working hours that only allow them to get barely enough rest, not to mention time for other things they want to do. They are able to support themselves financially, but not even able to do much more. And on the other hand, there are people who are struggling to have just enough to survive, who want to work but can’t get a job. They can’t do much either because they have to worry about finances, food, and survival. (Of course, there are also cases between the extremes). So, it seems that some are working for two or three while others don’t even get to work? Those who have the goods to stay alive don’t have the time to live and the others have the time but not the goods? Isn’t there a middle way?

Many years ago, people started to settle down, build houses, farm, and build more and more of a (world) economy. And it goes on steadily. It seems that everything we ever have is never enough. We have smartphones, cars, houses, etc., but we need bigger, smaller, faster, and so on. To get there, we (as humans) need to perform and work, but at what cost? We will never get where we want to go, there is always something that could be better, smaller, bigger, and so on – there is always more profit to be made. It has long ceased to be about providing us with what we need to live, to live well. It has long ceased to be about the living, rather it’s about the inanimate such as money and the power of those who have it.

This is neither healthy for the world nor for us. We are getting sicker and sicker – physically, mentally, and socially. That’s a high price to pay, and that’s not all – think about it: For all we know, we have to assume that as human beings we have only this one, finite life, and to spend it predominantly in a rush of achievement, attainment, earning and providing seems like a waste of that life – especially when there is not even enough time (and/or energy) left beside it for joy, play, love, creativity, self-development, seeing, hearing, feeling and being – for living.

Life should not mean work and work should not mean hardship, pressure, and burden. Working – understood as being productive and creative – is a part of life (any life – even the smallest microorganisms actively take care of their survival and we humans have always hunted and gathered for food and built for shelter), but it needs to be balanced in itself and with all other aspects of life.

So, I’m not arguing that development, innovation, and activity are bad things per se, but they should not be mainly about profit and power, but about us as humans, as individuals and as a community. Above all, we should develop positively as a human race. And life and all its parts should be in favor of living.

The questions that arise and that we need to think about are therefore: Is, paradoxically, the price of the way of life which we have created and which is supposed to sustain our lives, life itself? Is there a way out of this paradox? The point is: not only did we get ourselves into this mess, but the way of life as we have created it now seems to be a self-runner, and to stop it – to defeat the monster we have created – we need a huge shift in our thinking, in the way we deal with life and the way we make things (and ourselves) work – towards a balanced way of living.

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I am human.

I am not black – I am a human (who happens to have dark skin).

I am not gay – I love another human (who happens to have the same sex as I do).

I am not “trans” – I am a human (who happens to make some changes).

I am not a woman – I am a human (who happens to have breasts).

I am not a Muslim – I am a human with beliefs (which happen to be different from those of others).

I am not disabled – I am a human (who happens to not being able to walk).

We are all humans – no matter what circumstances we happen to live in or which we’re born into. Our circumstances differ in countless ways. But don’t we all breath the same air, live on the same planet, need to eat and drink to live, digest, bleed if we’re hurt, feel pain, get sad and laugh? The one thing which definitely connects us all is being human. Hating and hurting another because of skin color, sexuality, gender, ethnical background, religious beliefs etc. is to hate humans! Hating humans means to hate yourself! Stop projecting your own hatred and fear on to others! Stop hurting others because you’ve got issues with yourself and your own circumstances, your own life. Not only is this intolerable – it is unacceptable!

So, start dealing with your own being human and be gentle to yourself and to others! And if this isn’t something you can fully comprehend, just think about the term “human rights” – these are rights any human being possesses just because of being human and not because of having a certain skin color or nationality or whatever crap we make up to distinguish between inferior and superior or any other similar bias to cover up our own insecurities. And for all avowed egoists: If you’re not willing to care about the human rights of others, think about that: Violating human rights means to violate your own rights in the same instant. So be careful how you treat these rights, because with every violation which remains unpunished, ignored or accepted these rights lose worth and strength, and humans lose humanity.

For the record, I am a heterosexual white girl living in a European country. I have no experiences of being a victim of racism, homophobia or religious prosecution, so I have no expertise on that matter whatsoever, but I feel that if I would remain silent or withdraw due to the feeling of not being worthy or qualified to share my thoughts I would miss the chance of contributing anything beneficent at all. If I can inspire only one person to reflect on what I just said to maybe act more consciously or even change his/her/its mind or only a single person to feel seen or heard, I think it’s save to say: “It was worth it!”

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Reestablishing pre-COVID-19 “normality”?

These days many people seem to be longing for normality. Dreaming about “normal times”, a lot of people may ask: “When will everything go back to normal again?”. This desire for normality brought several other questions to my mind, which I want to elaborate on: What is normality? Has it been “normal” before the COVID-19 pandemic? Do we really want to go back to this so-called normality?

“Normal” or “normality” for me holds a great problematic potential. Isn’t it highly subjective what “normal” is? Or at least it is relative to the subjectivity of a group. But in its use “normal” implicates somewhat of an objectivity around things described that way, while there is none. Often “normal” too is understood as a certain average or common ground. I myself would like to exchange the word “normal” by “healthy”, which is indeed as well a subjective term. But: I think it isn’t implicitly linked to universality or objectivity. And if we would start asking the same questions we used to ask by using the words “normal” or “normality” and replace them with “healthy” or “health” these questions would turn into quite different questions, as well as their possible answers. Questions like “When will everything go back to normal again?” or “What can we do to restore our old, familiar normality?” become questions like “What does a healthy society look like?”, “What does a healthy world look like?” or “What has to be done/what can we do to achieve a healthier life/society/world?”.

On the one hand and without doubt this global crisis is a tragedy in so many ways and I don’t want to dismiss this. On the other hand it is also an opportunity for us as people to evolve into a healthier community/society. But to be honest, I’m really worried about the world letting this opportunity pass – more than about the virus itself at times. We’ve seen things work out nobody would have believed before, we’ve seen potential we stopped believing in. We’ve been witnesses of how forgiving the world and its nature can be – like dolphins returning near the coast of Sardinia, clear water in the canals of Venice or the vanishing smog which hovered the big cities, now offering a clear view of the blue sky and so on – if we acted more consciously and empathically. So, making excuses has become much more difficult.

This crisis is an opportunity to grow, it’s a wake-up-call. It’s a time to reevaluate life and how we treat ourselves, each other and the planet we’re allowed to call home. Humans work in a way that constantly seeks the familiar. The familiar serves the human pursuit of safety. We want the familiar, because it suggests safety. However, familiarity doesn’t necessarily mean safety, health or to lead a good life. We need to reflect on what we are used to and reevaluate its worth and meaning! There’s a shift in our thinking necessary: We may need to let go of the familiar – let go of things that have been passed down from generation to generation – to find the authentic, healthy way of life.

Longing for the old times – for “normality” – is a step backwards, a step in the wrong direction or even more a non-step, a stop. We’ve been given a chance to grow beyond ourselves, to outgrow our conditioning, to start living more consciously and to not settle for the familiar “normality”. So let’s not miss this chance. Let’s not try to restore the status quo. Let’s do better!

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COVID-19, spreading humanity?

In the past few days some thoughts came to my mind that I would like to elaborate on.

The first thought, it’s more of a question though, appeared as I left the drug store after my first visit since the corona virus outbreak had reached Austria: Why is it so hard to be friendly while keeping spacial distance? I know, we have to wear face masks and keep a certain distance and that these times are not easy, but does that mean we cannot greet each other? “A smile goes a long way” it says and, yeah, while wearing masks we don’t see each other’s mouths, but we can smile with our eyes or our voice or our words or even our body language.

There’s kind of a paradox going on it seems. While on the one hand people get out on their balconies to sing and cheer together, excited to show solidarity, on the other hand they just stare and don’t have a single “hello” to spare or buy so much toilet paper that the others can’t get any. I’m puzzled. For Austrians keeping distance emotionally seems to be a lot easier than keeping distance spatially, not only during corona though.

Second, it is often stated these days that people show more solidarity and humanity in this time of crisis. And I begin to wonder: What is humanity? What distinguishes ‘to act humanly’? What makes a certain behavior being considered inhumane? I always liked to think of behaving humanly as being respectful, giving, compassionate and understanding, which is surely true. But while reflecting on the meaning of it I came to think that there are characteristics which as well are part of humanity, like fear and suspicion that are not considered as praiseworthy. Of course, these could in a way be connected to our survival instinct.

So what shows up in this time of crisis? What is it we truly choose when we choose to show more humanity? Is it the compassionate and helping facet? Or is it the distrusting one? Or is it both, but intensified? I think for the most part we are able to decide which part gets stronger and which part we want to give to this world – not only in times of crisis. I would like to raise two subsequent questions to reflect on: Is there another disease spreading besides corona that is much more powerful and much more to be feared? And is this why we now have to face the corona virus pandemic to make meaningful decisions as humans?

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COVID-19, the moral thing to do.

I have some thoughts I want to share about the current situation regarding the corona virus outbreak happening all over the world. Not only here in Austria the government has initiated measures such as to prohibit leaving our homes – with certain exceptions and rules, i.e. buying groceries or going for a walk while maintaining a distance to others of at least 1m (if sufficient at all?). Therefore a lot of people stay at home, but there is also a significant number that do not.

It seems some people just do not see the importance of these measures. Maybe some of them are afraid of giving up their freedom – as for sure many are, whether they stay home or not. The fear of loosing our freedom surely is of meaning and absolutely understandable considering not only Austrias national-socialistic past. This is why I hypothesize that it is healthy not to feel comfortable with limiting our own freedom, because it shows awareness of yourself as an individual – among other things and mechanisms. I’m certainly not saying you should give up your fear, or rather your wish for freedom.

What I want is for you to consider that our own freedom ends where the freedom of another starts. And analogically, our obligations start where rights of others emerge and vice versa. People do have the (human) right to live as well as the (human) right of not being harmed (in German: Recht auf Unversehrtheit). Also, one of the basic principles of biomedical ethics is to do no harm. If you go outside to live on your social life and to act out your freedom you are interfering in these rights of other individuals. Especially of the ones who are older or have underlying health problems – such as people who have asthma or your grandparents, for example. By doing so you put their lives and welfare and those of the healthcare workers out there at risk. How can any healthcare worker help you or me or anybody if he or she is exhausted to an extent that he or she needs care or gets sick, mentally or physically?!

Frankly, you don’t have to be ok with the state enforced limitations, but please consider shifting your focus from defending your own freedom to protecting the safety of others for the time being, because it is our moral obligation to do so.