QUEERING, TRANSING, CRIPPING, AND MADDENING ASSISTED SUICIDE
What does it mean when it becomes harder to imagine (and so to provide) assistance with living than it does to imagine and provide assistance with dying (Chandler and Ignagni 2019)?
—ANNE MCGUIRE, “From Boomer to Zoomer. Aging with Vitality under Neoliberal Capitalism”
SOME DISABILITY ACTIVISTS/SCHOLARS, including Eliza Chandler and Esther Ignagni (2019), whom McGuire cites in her quote, point out that the question of death, whether assisted or not, cannot be dissociated from the question of life and conditions of living. While I wholeheartedly concur, I believe that too often assistance with dying (or assisted suicide) and assistance with living are treated as mutually exclusive in anti-oppressive social movements/fields of study. What happens if, from a queercrip perspective, we stop seeing these two forms of assistance, one for dying and the other for living, as incompatible and mutually exclusive and start perceiving them as constitutive and intersecting? Using this guiding question, in this chapter I bring together dying and living in a radical thanatopolitics (politics of death) that supports (assisted) suicide while simultaneously envisioning suicidal futurities and proposing an “ethics of living” (Fullagar 2003, 305) with suicidal people through structural changes that could improve their living conditions. Throughout the previous chapters, we have seen that suicide and assisted suicide are most often considered to be exclusive: One is deemed “irrational/alienated,” while the other seems “rational” from the right-to-die proponent’s perspective. In this chapter, I bridge the gap between the two, bringing them together in a new model: the queercrip model of (assisted) suicide. The usage of parentheses indicates the inclusion of conceptualizations of both suicide and assisted suicide. My queercrip model for conceptualizing (assisted) suicide provides an alternative to the medical, social, public health, and social justice models of suicidality (Chapter 1) and to the medical and rights-based models of assisted suicide (Chapter 4). My queercrip model of (assisted) suicide is informed by and anchored in social justice perspectives on suicidality and queercrip models of disability (including the socio-subjective model of disability; see Chapter 3), but it is also informed by the theoretical framework of suicidism and its derivative concepts, such as compulsory aliveness. This queercrip model, which builds on what Alison Kafer (2013, 14) calls “radical queercrip activism,” offers a counternarrative to dominant discourses on (assisted) suicide that represent somatechnologies of life detrimental to suicidal subjects. In this sense, this model aims to provide epistemic justice for suicidal subjects. To achieve this goal, this chapter is divided into four sections. While the first section presents my queercrip model of (assisted) suicide, the second introduces my suicide-affirmative approach and its characteristics, principles, and advantages. This approach, which may be mobilized at multiple levels (e.g., political, social, legal, or medical) is anchored in and promoted by the queercrip model of (assisted) suicide. The third section responds to potential objections to my suicide-affirmative approach. In the last section, I discuss the importance of developing an anti-oppressive thanatopolitics and call for coalitions between various social movements to fight for global social justice inclusive of various marginalized groups, including suicidal people.
5.1. Queercrip Model of (Assisted) Suicide
The need for a new model of suicidality is based on four observations discussed throughout this book and summarized here. First, no comprehensive model of suicidality that simultaneously theorizes suicide and assisted suicide from an anti-oppressive approach exists (Chapter 1). Generally, those using an anti-oppressive approach to analyze suicide do so by critiquing structural violence and oppressions that lead to self-inflicted death performed by suicidal subjects and by the state through assisted suicide (Chapters 2 and 3). In other words, an anti-oppressive endorsement of suicide and assisted suicide seems to be an oxymoron, a perspective I contest in this chapter. Second, a right to die involving positive rights (i.e., being entitled to receive assistance and services) and state support for suicidal people rather than for disabled/sick/ill/Mad/old people has, to my knowledge, never been defended (Chapter 4). In my research over the past decade, I have not encountered any scholar or author or activist who supports positive rights for suicidal people from an anti-oppressive approach in their work. Third, current models conceptualizing suicide and assisted suicide not only reproduce many -isms but also either actively reproduce suicidist oppression or leave it unproblematized. Indeed, as the various chapters in this book demonstrate, current discourses on suicide and suicide prevention strategies do more harm than good (also true of discourses on assisted suicide) and constitute powerful forms of somatechnologies of life and cruel optimism, or they denounce the mistreatment of suicidal people without proposing concrete actions to end suicidism and support suicidal people’s wishes. In that sense, suicidism and compulsory aliveness remain untheorized, even sometimes in social movements and in critical suicidology’s cutting-edge scholarship. Fourth, despite the “wars” to eradicate suicidality, be they from a medical, social, public health, or social justice perspective, people continue to want to die for various reasons, regardless of whether they are supported through assisted suicide. Suicidal people do not speak up and instead complete their suicides in private. Additionally, assisted suicides count for a high number of deaths in countries where this option is available; when it is not, the practice nonetheless continues underground.1 The popularity of the underground assisted suicide business is attested to by the massive interest in alternative technologies and do-it-yourself (DIY) methods of obtaining a peaceful death. Several million copies of books on DIY methods are sold every year.2 For all these reasons, I believe that we need to develop a model of (assisted) suicide that takes into consideration these facts and that has the potential to overcome some of the limitations of the other models.
My queercrip model of (assisted) suicide comprises two components, one descriptive and one normative. First, at the descriptive level, this model involves the recognition of structural suicidism and its impacts on suicidal people. Second, at the normative level, this model suggests the elaboration of a political agenda to end suicidism that involves accompaniment for suicidal people, including potential support through assisted suicide. As I mention in Chapter 1, I generally receive a dual reaction to this conceptualization of suicidality, anchored in these two components. While trans, queer, disabled/crip/Mad activists/scholars and critical suicidologists usually welcome my ideas on structural suicidism and agree that coercive treatments must be questioned, that it is crucial to have more open conversations about suicidality, and that we must recognize the violence suicidal people experience, they often emotionally resist the idea of supporting (assisted) suicide for suicidal people. For example, scholar Grace Wedlake (2020, 98), who adopts suicidism as a theoretical framework, admits that the complexity and messiness surrounding the suicidality of loved ones makes it hard to support their right to die (assisted or not). She describes her affective reaction (102):
Yet, while I recognize that my suicidal friends deserve agency in their decision to live or die, I also still struggle with how to put this tenet into practice. [ . . . ] I have yet to find a compelling explanation for executing this harm reduction approach in practice which recognizes the vulnerability, complexity, and pain that comes with opening yourself up to the idea that you might lose a friend [ . . . ]. Moreover, I have yet to fully let go of my—perhaps selfish—desire to fight for the people I love, and I continue to grapple with whether there is a way to both resist dominant suicide prevention discourses and fight for the suicidal people in your life to stay.
Wedlake’s reaction is typical of those I receive, often from nonsuicidal people, when presenting my queercrip model of (assisted) suicide. However, I hope that I have succeeded at this point in convincing readers that queering, transing, cripping, and maddening suicide and assisted suicide necessarily brings us onto a messy, complex, and intricate terrain, which requires us to take a step back and engage in self-reflexivity regarding our own presumptions, emotions/affects, and personal histories with suicidality.
As pointed out by some who have engaged with my theoretical prepositions, the implementation of my queercrip model of (assisted) suicide raises several questions.3 Indeed, the implementation of my queercrip model would require a paradigm shift in suicidology and critical suicidology as well as in the way we perceive suicide and assisted suicide. This queercrip model drastically changes the notion of duty for suicide and assisted suicide. From a duty to prevent suicide for suicidal people and a duty to support assisted suicide for “special populations” based on the ableist/sanist/ageist/suicidist ontology of assisted suicide, we turn toward a duty to support suicidal people and their needs, including through assisted suicide. The queercrip model of (assisted) suicide therefore aims to open our imaginations to what could happen if we started thinking about these issues through an anti-suicidist framework and an intersectional approach inclusive of suicidal people. My queercrip model is not a paint-by-numbers canvas providing answers to all the questions raised by the epistemological inquiry I propose in this book. Inspired by the abolitionist perspectives discussed in the Introduction, it is more of an “out-of-the-box” theory to start envisioning the profound transformations that an anti-suicidist perspective could precipitate when it comes to suicide and assisted suicide discourses, interventions, policies, laws, and social and cultural representations. However, following the “dis-epistemology” suggested by Liat Ben-Moshe (2020, 126), this queercrip model first requires us to let go of our certainty about (assisted) suicide “truths” and accept the unpredictability and unknown that come with such a radical transition.
In the spirit of transing (assisted) suicide, I like to think that suicidal people’s current realities share some similarities with those of trans people several decades ago, when trans rights did not exist, when trans-affirmative health care was not available, and when terms such as cisgender, cisgenderism, and cisnormativity did not exist. People were asking questions: What if more and more people want to transition? Who will pay for their treatments? What are valid motives to justify a transition? What should be the legal age to be able to transition? What about potential regrets following transitions? Who will be deciding who can transition? How will the state manage administrative forms and statistics if there are more than two sexes/genders? This list of questions is apparently endless. Those questions were (and still are) asked when trans issues are discussed. The first activists, health care professionals, and scholars who promoted the respect, inclusion, recognition, and agency of trans people did not have, at that time, the answers to these relevant questions. They had to formulate the answers as social attitudes, medical practices, and laws evolved. They first needed to open minds, hearts, and imaginations regarding trans identities. In essence, I want to do the same with my queercrip model of (assisted) suicide.
This analogy shows the necessity of first acknowledging the possibility of transition as a valid option before answering questions about the who, what, when, where, why, and how of sex/gender transitions. The same is true for (assisted) suicide. Questions about (assisted) suicide touch every aspect of our societies: What if more and more people want to access assisted suicide? What if the suicide-affirmative approach destigmatizes suicidality and makes death appealing for people in temporary distress? How do we distinguish a genuine wish to die from an impulsive one? What are justifiable motives for allowing assisted suicide? Who will administer assisted suicides? Who will pay for assisted suicides? What should be the minimum age to access assisted suicide? What about the moral obligation that some suicidal people, such as single parents with young children, might have toward others for whom they care? How do we avoid the slippery slope between voluntary assisted suicide and involuntary practices, such as involuntary euthanasia? Can someone prepare advance directives for their assisted suicide? If assisted suicide is made accessible to everyone, will it disproportionally affect marginalized communities? How can we develop interventions based on informed consent in such life-changing decisions? How many days, weeks, or months must a person wait before having access to assisted suicide? How should we intervene in crisis situations based on an anti-suicidist framework? The list of questions is apparently endless. Yet before turning to them, we must begin by envisioning suicide and assisted suicide as valid, even positive options in some cases. The goal of this book is to open these possibilities in our minds and hearts; to start naming, conceptualizing, and denouncing suicidism; and to begin envisioning what a sociopolitical agenda or thanatopolitics to combat structural oppression faced by suicidal people might look like, as I discuss in the rest of this chapter. Answering these questions is crucial, but I believe that it needs to happen after first acknowledging the possibility of assisted suicide for all individuals, including suicidal people.
Without repeating my arguments on the queering, transing, cripping, and maddening of (assisted) suicide, I insist here that my queercrip model is nourished simultaneously by the antisocial turn in queer theory and its notions of negativity, anti-futurity, and failure; by a queer affective and relational turn regarding suicidal people; and by a crip futurity imagination. From anti-ableist and anti-sanist perspectives, the model condemns the dismissive and discrediting attitudes toward suicidal people, who are often labeled as “irrational,” “mad,” “crazy,” “insane,” or too “alienated” to understand their choices. The model also rejects the ableist/sanist/ageist/suicidist logic underlying current right-to-die discourses. It calls for a politics of compassion, responsibility, and accountability, capable of supporting suicidal people in all spheres in which they want to exercise their agency and self-determination, including their desire to die through assisted suicide. Most importantly, this model is meant to complement, not supersede, the fight against oppressions that influence suicidality for marginalized groups. Let me be clear: This queercrip model does not propose a quick and individualist solution to put all of those affected by heterosexism, cisgenderism, ableism, sanism, colonialism, racism, capitalism, or ageism out of their misery through assisted suicide without fighting the oppressive systems that made their lives unlivable in the first place. On the contrary, this model is anchored in a combat against all violent systems, including the suicidist system. This model posits that fighting for social transformations and social justice is not antithetical to greater accountability to the lived experiences of suicidal people, the stigma they face, the prejudices they live (and die) with, and the structural suicidist violence they experience.
This queercrip model of (assisted) suicide is inspired by liberatory epistemologies, such as Black epistemologies (Hill Collins 2000; Medina 2012) and trans epistemologies (Radi 2019). As explained in Chapter 1, it is anchored in a suicidal epistemological standpoint that recognizes the legitimacy, credibility, and expertise of suicidal people as knowledgeable subjects on the topic of (assisted) suicide. My queercrip model is also guided by what Katrina Jaworski (2020, 598) considers to be the two “philosophical principles and attitudes” necessary when we study suicidality: wonder and generosity. More than principles and attitudes, wonder and generosity form the basis of what she considers to be an ethical approach to suicide, which includes active forms of listening to suicidal people (596): “Exercising wonder and generosity can be useful when we listen to people who survived their attempt. This kind of listening means that we respect their choices as their own, based on the meaning they attribute to it.”4
In sum, my queercrip model aims to dismantle oppressive systems that propel some marginalized groups more than others toward suicidality. It also aims to dismantle suicidism, compulsory aliveness, and the injunction to live and to futurity. This model allows us to go beyond the “compulsory ontology of pathology” (Marsh 2010b, 4) regarding suicidality and to problematize suicidism. It also allows us to envision assisted suicide from an anti-oppressive approach that goes beyond the ontology of assisted suicide limited to disability/sickness/illness/madness/old age. This double critique of these ontologies, one related to suicide and the other to assisted suicide, opens up the possibility of supporting assisted suicide for suicidal people from an anti-oppressive approach. This model would also create safer spaces to openly discuss suicidality and the desire to die, simultaneously creating the space to find potential alternatives to continue living for some suicidal people. In that sense, this model embraces an “ethics of wonder and generosity” toward suicidal people and constitutes an ethics of living with them, since it opens channels of conversation and provides suicidal people with the support they need, whether they choose to continue living or prefer to die. While the queercrip model of (assisted) suicide opens imaginations to conceptualize suicide and assisted suicide differently at the epistemological and theoretical levels, it also serves as the foundation for developing alternative approaches in relation to (assisted) suicide, such as the suicide-affirmative approach I propose in the next section. In that sense, the suicide-affirmative approach could be seen as a first step in the concretization of the radical transformation proposed by the queercrip model of (assisted) suicide.
5.2. Suicide-Affirmative Approach
My suicide-affirmative approach is anchored in and promoted through the queercrip model of (assisted) suicide, and it may be mobilized at numerous levels: theoretical and epistemological (e.g., scholarship), legal (e.g., laws), political (e.g., public policies), social (e.g., cultural representations and social attitudes), medical/psychological (e.g., health care and social services), and so forth. When mobilized in health care and social services, the suicide-affirmative approach may be translated into “suicide-affirmative health care” (Baril 2020c, section 2.3.2), similar to the trans-affirmative health care offered to trans communities. In the same way that a trans-affirmative approach informs health care, interventions, social policies, laws, and research to gradually make our anti-trans societies and institutions more respectful and inclusive of trans people, a suicide-affirmative approach could be wholeheartedly embraced during the transition from suicidist to anti-suicidist societies. It is crucial to mention that my suicide-affirmative approach is life-affirming and death-affirming: It is less an approach that only promotes a right to assisted suicide than an approach focused on the accompaniment of people who are considering death by (assisted) suicide to help them to make the best-informed decisions. The suicide-affirmative approach departs radically from the medical right-to-die discourses founded in ableism/sanism/ageism/suicidism and from the rights-based model, such as the one suggested by Exit International. The logic behind right-to-die discourses is often derived from neoliberal policies and what Sally Chivers (2020, 52) calls “austerity thinking”—that is, the logic of cuts to save money as well as the way we think about ourselves and our lives. The suicide-affirmative approach clashes with mainstream conceptualizations of the right to die, not only in the anti-oppressive values at the core of my approach but also in terms of the criteria and goals of support for assisted suicide. Indeed, the logic behind my suicide-affirmative approach is not an “austerity thinking” or a logic of disposability of marginalized communities. Quite the contrary: It focuses on the most marginalized people in our societies and aims to combat multiple forms of -isms, including forms unrecognized so far within social movements, such as suicidism. This approach would require resources and investments for improved (universal) health care, better living conditions, psychological and community support, and so on. In sum, while the right to die by assisted suicide is almost always cast by anti-oppression activists/scholars as one of the most conservative and violent positions someone can endorse, the suicide-affirmative approach shows that supporting a renewed form of assisted suicide does not go hand-in-hand with political conservatism, austerity thinking, and ableist/sanist/ageist/suicidist logic.
In the spirit of the emerging field of queer death studies (Petricola 2021; Radomska, Mehrabi, and Lykke 2019), my suicide-affirmative approach historicizes and politicizes death rather than seeing it as a natural event. The passage from life to death, be it through a so-called natural death or by (assisted) suicide, is a deeply social and relational passage, whose sociality and relationality are nevertheless denied for suicidal people, since, in the absence of a suicide-affirmative approach, they are condemned to die alone if they want to complete their suicide. The suicide-affirmative approach insists on the importance of an affective and relational turn regarding suicidal people. It takes into consideration suicidal people’s subjective experiences of suffering, regardless of the source(s) of suffering. It opens up the possibility of exploring suicidality without shame and guilt. It allows us to explore with them crucial questions: What appeals to you about the option of (assisted) suicide? What kind of support or help do you need to go through this difficult period of your life or to end your life? Did you inform your relatives and friends about your wish to end your life, and do they support you in this process? Did you consider other options? Did you consider all the implications of this decision? Did you plan your end of life, death, and post-death? Similar to a trans-affirmative approach, the suicide-affirmative approach offers care, compassion, and support through an informed consent model, taking for granted that the expert in the decision to transition—in this case, from life to death—is the person making the decision. Like a trans-affirmative approach, it does not push people to transition or, in this case, complete an assisted suicide but offers a safer space to explore all possible options.
The suicide-affirmative approach focuses on the voices of suicidal people who, despite the epistemic forms of violence they face, including pervasive forms of testimonial injustice and hermeneutical injustice and marginalization (see Chapter 1), have something important to share but are too often not listened to. It seems cruel to force life on a person who does not wish to live in the name of an injunction to futurity and because nonsuicidal or ex-suicidal people believe that they know best what is good for suicidal people. When Graeme Bayliss expressed on CBC Radio’s The Current his desire to die, it was fascinating to hear how everyone—psychologists, sociologists, and various other “logists”—made pronouncements about what his fate should be (i.e., continue living), confident in the belief that they knew best. My approach seeks to create safer spaces in which the voices of suicidal people can be heard, legitimized, and, in Foucauldian terminology, desubjugated. These safer spaces must be as free as possible from forms of judgment, stigmatization, paternalism, and oppression and must foster a welcoming environment so that suicidal people can freely express their lived experiences, thoughts, and demands without fear of reprisals or suicidist consequences. This approach recognizes the pain and suffering that social oppressions and/or mental and psychological disabilities may cause without using suicidal people’s mental and psychological condition to invalidate their agency and without using their social alienation to deny their agency. It suggests that we work on multiple levels simultaneously; while it is necessary to tirelessly tackle the sociopolitical oppressions that may create or intensify suicidal ideation, we must also acknowledge that suicidal people’s experience of suffering is real and respect their need to end their life after careful consideration through a supportive process of accompaniment.
5.2.1. Ten Principles of a Suicide-Affirmative Approach
To make my suicide-affirmative approach easy to understand, I outline ten principles that lie at its core. I am inspired by the principles that guide harm-reduction approaches, such as those of Trans Lifeline (see Chapter 2). Although each principle could be developed extensively, my goal here is to remain succinct. I elaborate the last two principles further, since the harm-reduction approach and assisted suicide support for suicidal people through informed consent are the most controversial principles of my approach.
Principle 1: Adopting an Anti-Suicidist Framework
It is essential that a suicide-affirmative approach adopt an anti-suicidist framework (see Chapter 1). As previously mentioned, aiming to cultivate safer spaces starts with the recognition of the oppressions faced by affected groups. Supporting trans people without recognizing cisgenderism would be ineffective; the same underlying principle is true for suicidal people. The recognition of structural suicidism allows us to name and denounce the oppression endured by suicidal people, reject the naturalization of this oppression by a pathologizing gaze, and acknowledge that measures must be taken to end this oppression.
Principle 2: Endorsing an Intersectional Lens
As demonstrated throughout this book, suicidism is interlocked with other forms of oppression, particularly ableism, sanism, and ageism, but also classism, capitalism, colonialism, racism, heterosexism, cisgenderism, healthism, and sizeism, to name but a few. A suicide-affirmative approach that does not use an intersectional lens would fail to understand the role of interconnected forms of oppression in the lives of suicidal people. For example, as discussed previously, suicidal people who are disabled/sick/ill/Mad/old, racialized, or poor are treated differently than suicidal people who are able-bodied/-minded, healthy, young, White, or financially privileged.
Principle 3: Understanding Suicidality as a Complex Phenomenon
A suicide-affirmative approach should avoid simple and reductive (causal) explanations of suicidality, be they anchored in the medical, social, public health, or social justice models of suicidality. Understanding suicidality only through the lens of mental illness, social oppression, or social determinants of health deprives us of more robust and complex readings of the multi-faceted components of suicidality. Most importantly, limited conceptualizations of suicidality often remain anchored in a suicidist preventionist script, which tries to understand the “why” of suicidality to prevent it instead of focusing on how to support the needs of suicidal people. Seeing suicidality as a complex phenomenon allows us to go beyond a unilateral negative view of it as something to be “fixed.”
Principle 4: Embracing a Nonjudgmental Attitude
An approach that is suicide-affirmative requires us to embrace a nonjudgmental attitude toward suicidal people. Just as the trans-affirmative approach requires us to remain self-reflexive, self-critical, and aware of power relations in cis/trans interactions, nonsuicidal people should be aware of power relations in suicidist regimes and remain vigilant against imposing their perspectives, preferences, or judgments on suicidal people. They should critically approach notions discussed in an anti-suicidist framework, such as compulsory aliveness and the injunction to live and to futurity, and determine how this system of intelligibility is ingrained in their reactions toward suicidal people and (assisted) suicide.
Principle 5: Encouraging Initiatives by and for Suicidal People
If one thing cross-pollinates all social movements, it is the importance of centering our reflections, actions, and political agendas on the voices of the people primarily concerned. A feminist movement in which men’s voices override women’s voices or an anti-racist movement in which the voices of White people are prioritized undermines the values of these movements. As “Nothing about us without us,” an often-mobilized slogan in disability activism/scholarship, expresses the importance of disabled people in the fight against ableism, a suicide-affirmative approach aims to encourage initiatives by and for suicidal people, in which their voices are not only heard but also valued and prioritized.
Principle 6: Promoting Peer and Community Support
There are, even in mainstream suicide prevention programs, many initiatives focused on community support, and these are encouraged from a suicide-affirmative perspective. Rarer are peer-support programs (such as discharged; see Chapter 2), which should occupy more space in the landscape of suicide intervention. Instead of fearing that suicidal people will naïvely or, worse, defiantly encourage suicide in others, based on moral panic discourses surrounding suicidality and its potential “contagion,”5 a suicide-affirmative approach regards suicidal people as knowledgeable subjects with an expertise on suicidality and a rich lived experience that can be helpful for others.
Principle 7: Refusing Nonconsensual and Coercive Interventions
Activists/scholars in the anti-psychiatry and Mad movements/fields of study have proposed innovative and compassionate ways to respond to people with mental illnesses or Mad people in crisis (Ben-Moshe 2020; Dixon and Piepzna-Samarasinha 2020; Fireweed Collective 2020). These noncoercive and noncarceral approaches should be extended to suicidal people. A few authors and organizations have started to refuse nonconsensual and coercive interventions in relation to suicide.6 As demonstrated throughout this book, nonconsensual and coercive interventions with suicidal people are not only suicidist but also based on, and simultaneously fuel, other forms of violence, such as sanism, racism, or cisgenderism. This demonstration should suffice to show that if activists/scholars employ an intersectional lens, they should also refuse nonconsensual and coercive interventions that more negatively affect people living at the intersections of multiple oppressions.
Principle 8: Valorizing Autonomy and Self-Determination
The notions of autonomy and self-determination have been debated from multiple points of view, making it difficult to mobilize these all-embracing concepts without lengthy explanations. I would specify that the notion of autonomy I have in mind, inspired by feminists and other activists/scholars from various social movements/fields of study, is relational—that is, not conceptualized in silo but seen as intertwined in a vast array of (power) relations and influences (e.g., Gill 1999; Ho 2014). Autonomous decisions and self-determination are not conceptualized in a vacuum here, and I recognize that our personal relationships (e.g., family and friends) and oppressive systems can play a central role in suicidality in marginalized communities. The same is true for numerous decisions, such as having children, doing sex work, or having recourse to cosmetic surgeries or trans-affirmative surgeries. Despite the personal, social, cultural, political, legal, medical, religious, and economic structures influencing our everyday decisions, if we can recognize that we are still agentive subjects capable of self-determination, the same should be true of (assisted) suicide. In sum, in a suicide-affirmative approach, no double standard should exist regarding people’s capability to exercise their autonomy and self-determination in relation to their death.
Principle 9: Adopting a Harm-Reduction Approach
Central to my suicide-affirmative approach is a harm-reduction approach. Based on the empirically supported premise that it is impossible to stop people from ending their own lives if they are determined to do so (even in the context of incarceration and forced institutionalization), a harm-reduction approach seems more relevant than one aiming to eradicate suicide. A Google search of the terms harm reduction and suicide performed in August 2021 reveals the extent to which the harm-reduction approach has not yet been mobilized in the context of suicidality per se, except in my previous work (Baril 2017, 2018, 2020c). When a few rare authors suggest using a harm-reduction approach to suicidality, they understand the concept in a quite literal sense, i.e., reducing the harm caused by suicidality to suicidal people and their surroundings. For example, neuropsychologist Jerrold Pollak (2020, 29) writes, “The goals of programs based on this [harm-reduction] model include improved safety, reduced risk, and amelioration of comorbid medical and psychiatric conditions that contribute to elevated risk.” My perception of a harm-reduction approach applied to suicidality clashes with Pollak’s. In the context of a suicide-affirmative approach, adopting a harm-reduction lens involves recognizing that in the current suicidist context, it is not necessarily suicidality per se that is risky or negative but mostly what surrounds it—for example, the criminalization of suicidality, the violence of involuntary commitments, or the impacts of coercive treatments. The goal of harm reduction in this case is to ensure that when a person decides to express their suicidality or pursue their suicide, they have all the data for making an informed consent, they have been presented with various alternative options, they know that they would be supported in choosing otherwise, and they are provided with the best support and care if they choose to pursue their (assisted) suicide.
The harm-reduction approach has been mobilized in a variety of contexts to support various marginalized groups, including sex workers, drug and substance users, and people with “risky” sexual behaviors. This approach is not based on a logic of prohibition or abstinence, even though the popularization of the approach in the past two decades has led to problematic ways of mobilizing this approach from prohibitionist stances. More generally, however, the harm-reduction approach lies in the belief that some people will continue to engage in stigmatized activities and that, from a compassionate and pragmatic stance, they need to be respected in their decisions and supported to reduce the harm that could occur from those practices.7 As scholars Susan E. Collins and colleagues (2012, 6) point out, harm reduction is more of an “attitude” toward social issues:
This overarching attitude has given rise to a set of compassionate and pragmatic approaches that span various fields, including public health policy, prevention, intervention, education, peer support, and advocacy. These approaches aim to reduce harm stemming from health-related behaviors [ . . . ] that are considered to put the affected individuals and/or their communities at risk for negative consequences [ . . . ]. These approaches also seek to improve QoL [quality of life] for affected individuals [ . . . ,] [which] grew out of a recognition that some people will continue to engage in high-risk behaviors even as they experience associated harms. For these individuals, harm reduction approaches provide a middle way alternative between total abstinence and continued harmful use/behaviour and thereby open other pathways for change, while reducing negative consequences for both the affected individual and their communities. [ . . . ] Harm reduction reflects a humanistic perspective: people will make more health-positive choices if they have access to adequate support, empowerment, and education.
This humanistic, compassionate, nonjudgmental, and nonpathologizing attitude, focused on empowering groups often living at the intersections of multiple oppressions, fits well with the “ethics of wonder and generosity” proposed by Jaworski and that I embrace. Many marginalized groups and community organizations that support them endorse a harm-reduction approach, which is often seen as central to trans, disability, and transformative justice movements (e.g., Dixon and Piepzna-Samarasinha 2020). Despite the heuristic value of this approach, it seems that no activists/scholars had mobilized it with suicidal people until I started proposing it (Baril 2017, 2018, 2020c). Scholar Russel Ogden (2001) briefly evokes harm reduction in relation to a right to die for disabled/sick/ill people but does not extend the idea to suicidal people.8 Similarly, while Amy Chandler (2016, 2019), Elizabeth McDermott and Katrina Roen (2016), and Katrina Roen (2019) mobilize the harm-reduction approach from queer perspectives on self-harm, they do not extend it to suicide per se.
The harm-reduction approach I am putting forward here would complement, not replace, fighting systemic oppressions contributing to the over-representation of marginalized groups in suicide rates. This harm-reduction approach with suicidal individuals would include support during each step of the process for people who express a desire to die. Finally, I would like to point out that current conceptualizations of suicidality that endorse the suicidist preventionist scripts are, in some ways, implicitly endorsing an “abstinence” perspective on suicide. Indeed, the necessity to avoid suicide at all costs, or the idea that suicide should not be pursued or supported, is a philosophy that promotes a discourse of “abstinence.” Instead, I believe that it would be helpful to extend the nonstigmatizing and nonjudgmental values of harm reduction, embraced in numerous anti-oppression circles, to (assisted) suicide. Adopting a harm-reduction approach implies recognizing the complexity and messiness inherent in providing help, support, and rights in relation to practices that are not considered “optimal.” For example, transforming laws, social policies, institutions, and interventions to allow heroin users to safely use drugs could at first seem counterintuitive, since studies have demonstrated the devastation heroin use causes. The harm-reduction approach invites us to see beyond the idea of providing support for a practice not considered optimal: Through that support, drug users have multiple opportunities to interact with practitioners who can offer them advice about their health, discuss alternatives to drug use, offer access to counseling, and provide safer materials for injection. In other words, the harm-reduction approach does not encourage drug use per se; it simply recognizes that drug users exist and supports them in their practices and in their potential desire to find alternatives to drug use. The same is true about the harm-reduction approach I propose to apply to (assisted) suicide. (Assisted) suicide is not a panacea, and through my suicide-affirmative approach, my hope is not to encourage or increase suicidality but rather to better support and accompany suicidal people.
Principle 10: Supporting Assisted Suicide through Informed Consent
One final but crucial principle that guides my suicide-affirmative approach is to support assisted suicide by using an informed consent model employed with other marginalized groups. It is important to first reiterate what I mean by assisted suicide, even though I have discussed my definition in other chapters. I use the term assisted suicide as an umbrella term to refer to multiple voluntary practices intended to cause death. I am not referring to involuntary forms of death, such as involuntary euthanasia (“against the wishes expressed by a competent person” [Downie 2004, 7]) or nonvoluntary euthanasia (“without the knowledge” of the person [Downie 2004, 7]). These involuntary and nonvoluntary practices are unacceptable because they are not founded on informed consent. In opposition, assisted suicide on a voluntary basis (including what is sometimes called voluntary euthanasia) is founded on a person’s wish and request to access support to voluntarily cause their death. Some authors mobilize the umbrella expression assisted death to refer to all these forms of assistance in dying, but, from a queercrip perspective, I prefer to retain the term assisted suicide, which contains the word suicide as resignified in this book.
In some countries (e.g., Switzerland and the United States), health care professionals are prevented from actively participating in voluntary euthanasia, defined as “an act undertaken by one person with the motive of relieving another person’s suffering and the knowledge that the act will end the life of that person” (Downie 2004, 6). In these contexts, the person requesting support to die is provided with the knowledge and drug prescription they need to accomplish their suicide on their own. In other countries (e.g., Belgium, Canada, and the Netherlands), voluntary euthanasia is allowed. In Canada, for example, medical assistance in dying (MAID) law distinguishes between “clinician-administered medical assistance in dying” and “self-administered medical assistance in dying,” and both forms are allowed. When I state that a suicide-affirmative approach should support assisted suicide, I refer to these various voluntary practices. Allowing only forms of self-administered death is ableist, since some people with disability/sickness/illness cannot self-administer the lethal treatment for various reasons (e.g., tremors or difficulty swallowing). Thus, the assisted suicide I have in mind could be administered either by the person who wishes to die or by another person.
This suicidal person should be competent—that is, “capable of understanding the nature and consequences of the decision to be made” (Downie 2004, 7). In light of the discussions in Chapter 3 about pervasive forms of sanism, ageism, and suicidism, which strip marginalized individuals of their mental competence, it is crucial to understand that I am not using the notion of competency in a restrictive, ableist/sanist/cogniticist/ageist/suicidist sense. Mental competence should be assessed on a case-by-case basis, one decision at a time. The simple presence of a mental illness, mental or cognitive disability, madness, or suicidality should never constitute a reason to assume that the person is not competent to make decisions about their body, health, life, and, in this case, death. Simultaneously, the relational notion of autonomy I embrace recognizes the influence of others in our lives as well as the roles of structural factors and oppressions in our decisions. Keeping this in mind, a suicide-affirmative approach aims to support and accompany suicidal people to help them critically reflect on their decisions during a certain period of time, thus avoiding offering assisted suicide to a person who is in a temporary, acute mental/emotional crisis or under undue influence (e.g., family pressures or social or economic constraints). I am often asked how long the waiting period should be to ensure that people in temporary crisis do not have access to assisted suicide. I believe that unless there are circumstances in which someone is facing imminent death, in which case the process could be accelerated, the accompaniment should last at least a few months to prevent rushed decisions that could be taken in the middle of an acute mental health crisis or any other kind of crisis (e.g., financial or relationship) resulting from personal and/or social factors.
I envision assisted suicide support as relying on an informed consent model, which is used more generally in health care (Eyal 2011) and with some marginalized communities, such as trans people (Kirby 2014; Pearce 2018; Winters 2006). Scholars Damien W. Riggs and colleagues (2019, 921) describe the informed consent model as follows, in accordance with a trans-affirmative approach:
Transgender people have sought to develop affirming approaches to clinical research and practice that challenge the broader psy disciplinary regulation of their lives. Key to affirming clinical approaches has been the recent development of the informed consent model of care, developed in partnership with transgender people [ . . . ]. Rather than centering clinician diagnosis and authorization for treatment, this model of care emphasizes that transgender people are more than capable of authorizing their own treatment in collaboration with clinicians [ . . . ]. Such an approach challenges traditional models of care [ . . . ], which in many instances continue to gatekeep access to care. Furthermore, an informed consent model recognizes that, in many cases, transgender people know more about their needs than many clinicians [ . . . ].
The informed consent model allows people to lessen the power of health care professionals and the medical-industrial complex. My goal is not to empower actors of the medical-industrial complex but to empower the people most concerned. While it is difficult to undergo a medical sex/gender transition without medical support or a life-to-death transition without medical support (contrary to what people might think, it is difficult to cause death, as testified by numerous people who survived their nonfatal suicide attempts9), it is crucial to not fall into a medical model of assisted suicide, guided by the ontology of assisted suicide founded on ableist/sanist/ageist/suicidist criteria (see Chapter 4). An informed consent model addresses this problem, as it shifts the decision-making from the gatekeepers’ hands to suicidal people’s hands. The suicidal person would be accompanied to make decisions that would then be supported by health care providers.
5.2.2. Advantages of a Suicide-Affirmative Approach
In the current suicidist system, as demonstrated in Chapter 1, suicidal people are afraid to discuss their suicidality. Such fears could be transformed by a suicide-affirmative approach to break the isolation at the core of suicidality and encourage suicidal people to seek services. This approach could also radically shift the ways in which practitioners offer such services. At present, many practitioners fear liability if their client dies by suicide (Borecky, Thomsen, and Dubov 2019; Stefan 2016), leading them to adopt intervention strategies that negatively affect suicidal people, such as rushing to contact emergency services as soon as suicidality is evoked. A change in the discourses on suicide, from “suicide is never an option” to “suicide is always an option,” would allow them to truly explore their clients’ death wishes and to accompany them without imposing certain treatments or courses of action. In the remainder of this section, I focus on four additional advantages of a suicide-affirmative approach.
The first advantage is that by recognizing the expertise and legitimacy of suicidal people as knowledgeable subjects, we would promote epistemic justice and treat them like other marginalized groups who ask that their perspectives be valued and recognized. Crucially, many people experiencing suicidal ideation are part of multiple marginalized communities. Adopting a suicide-affirmative approach that would allow people to openly discuss their mental/emotional distress would necessarily offer greater support to those living at the intersections of numerous oppressions and who typically do not reach out for fear that revealing their distress will simply increase the colonialist, racist, heterosexist, cisgenderist, ableist, or sanist violence they already experience. When we consider, for example, that “a staggering 39% of [trans] respondents experienced serious psychological distress in the month prior to completing the survey, compared with only 5% of the U.S. population” (James et al. 2016, 5), I have strong reason to believe that a suicide-affirmative approach would have positive outcomes for populations affected by multiple oppressions.
The second advantage of a suicide-affirmative approach is that it would result in a less lonely and/or violent death preparation and death and avoid the consequences of “botched suicides,” in the words of some suicidal people (Paperny 2019a; Scully 2020). As I suggest earlier, without falling into an ableist trope about disability/sickness/illness following nonfatal suicide attempts, it is important to understand that suicide attempts come with long-term physical and psychological/emotional traumas and consequences. Supporting assisted suicide would diminish those consequences. Suicidal people would not only have more time to reflect on the implications of their decision, possibly resulting in fewer completed suicides, but completed suicides would be less violent and “risky” in terms of potential outcomes. Indeed, while assisted suicide through medical methods are not 100 percent successful on the first attempt (Engelhart 2021), the presence of professionals ensures that all the steps are followed to make death occur peacefully. On the contrary, many suicide attempts, such as by poisoning or ingesting drugs, lead to excruciating days of suffering before the person is found and “rescued” from their misery or dies alone. Having contemplated suicide, along with many others, like Anna Mehler Paperny, Bayliss (2016, para. 4) explains:
The fact is, killing yourself is a fantastically tricky thing to do. [ . . . ] Guns can misfire, ropes can snap, drugs can induce vomiting and leave you with little more than a sore stomach and a fucked-up liver. Around 40 percent of subway jumpers survive [ . . . ]. Just 5 percent of wrist-cutters are successful. Most suicidal people are aware of the risks, aware that whatever attempt they make on their own life is statistically likely to fail and cause them greater pain and humiliation, to compound their sadness and anxiety and loneliness and make life even more wretched and grey.
As Bayliss mentions, not only is suicide a difficult thing to accomplish alone; nonfatal attempts, in the current suicidist context, lead to further stigmatization and loneliness, which in turn increase suicidality. Therefore, a suicide-affirmative approach would allow for careful reflection on life and death as well as a peaceful death, if chosen, and all the help to prepare for that event. A person could therefore fulfill their last requests and could be surrounded by the people they love during this passage.
The third advantage of a suicide-affirmative approach is that the completed suicides would also be less traumatic for families and friends. Literature discussed in this book is replete with statements about families and friends being “traumatized” by suicide. As discussed in Chapter 1, this reason is why some people use the vocabulary of survivalship not only for suicidal people who survive their attempts but also for those left behind when suicides are completed. I will not repeat my critiques about the usage of the term survivors of suicide to refer to families and friends, but I want to point out that what is often as equally traumatizing as the death itself is the existence of the suicidist system in which suicide occurs. First, because suicidal people conceal their plans in a suicidist system, the suicide arrives as a surprise, even though sometimes relatives knew that the person was suicidal. Second, this “don’t ask, don’t tell” policy leads many family members and friends to wonder “why” the suicide happened, what they could have done differently to support the person, or what they would have said or done had they known that this was their last interaction with the person. In other words, the effect of surprise and the silence preceding the suicide trap family members and friends in negative emotions, such as guilt, shame, or anger (toward themselves or the suicidal person). Third, because of the stigma surrounding suicidality, family members and friends who lose someone by suicide experience a different grief than those who lose someone in nonsuicidal circumstances; on top of their sadness about their loss, they often do not reveal the cause of death for fear of stigma (Joiner 2005). Studies show that when they do reveal it, they do not get the same caring support offered to other people who have lost someone through other forms of death (Beattie and Devitt 2015; Friesen 2020). Fourth, it is quite traumatic for families and friends to find a dead body following a suicide; the violent methods used to complete suicide (e.g., cuts, fire, strangulation, or gunshots) leave unbearable memories for those who find the corpse of their loved one. I want to insist that all these negative consequences, which burden families and friends, are caused not by the suicidal person or the suicide itself but by the suicidist environment in which the suicide is carried out. If a suicide-affirmative approach were adopted, the surprise effect would be moot, since suicidal people would be accompanied in discussing their death with the significant people in their lives. The silence and lingering questions as well as feelings of guilt or shame would probably diminish: Family members and friends would have had the time to speak with the person, ask them questions, voice their worries and preoccupations, and show their love and support before the person left. A suicide-affirmative approach may provide them with peace of mind, knowing that they did everything they could and giving them the opportunity to mindfully carry out their last interactions with the person. A total destigmatization of (assisted) suicide would also help with the mourning process of family members and friends: Similar to other forms of death, people in mourning would receive the support they deserve and feel less obliged to conceal details about the death. A suicide-affirmative approach, with assisted suicide support, would also prevent the traumatic discoveries of bodies shattered by gunshots or mangled through violent impacts. Finally, people who were aware that someone close to them was suicidal, as was the case for Maier-Clayton’s family (Engelhart 2021), would have the opportunity to offer support to the suicidal person without fearing criminal prosecution (Stefan 2016). In sum, without dismissing the difficult emotions experienced by the relatives and friends of a suicidal person, my point is that my suicide-affirmative approach would reduce their trauma instead of increasing it.
The fourth advantage of a suicide-affirmative approach is that it may save more lives than current prevention measures (Baril 2017, 2018, 2020c). When I discuss my work, this advantage often garners the most interest from audiences, perhaps since it fuels the suicidist preventionist script. I am deploying this argument cautiously, since the ultimate goal of my suicide-affirmative approach is not to save more lives. Saving more lives is a beneficial side effect of abandoning the preventionist script, not its primary goal. Importantly, this advantage, like the others, remains hypothetical. It cannot be otherwise, since a suicide-affirmative approach has never been implemented in any historical or geographical context. However, where alternative approaches to suicidality have been tried, including those aligning to some extent with a suicide-affirmative approach, such as offering noncoercive, peer-support interventions, such as Trans Lifeline or the discharged project (Chapter 2), results are encouraging. For example, Trans Lifeline (2020, 139) states:
For many in our community, chronic suicidal ideation is a response to trauma and can be managed. When we validate each other’s feelings, share lived experiences, and speak candidly about crisis and suicidality, we have a higher rate of success than we would if a caller felt their trust violated by nonconsensual active rescue. At Trans Lifeline, we view people in crisis as human beings with agency and the ability to have a conversation without a need for nonconsensual intervention, and we see positive results from that approach.
Those who have dissident perspectives such as this one are often discredited or simply ignored in suicide intervention milieus. However, more and more voices in critical suicidology insist on the importance of these alternative approaches to suicide and their potentially positive results.10 Additionally, while my suicide-affirmative approach does not support current forms of assisted suicide laws, the empirical results from the countries where people can access assisted suicide solely on the basis of psychological/emotional distress are informative. Indeed, while some people complete their assisted suicide after being accompanied and having met all the criteria, others regain a desire to live through the process of accompaniment. Several clinicians who offer assisted suicide, such as Lieve Thienpont (Thienpont et al. 2015), testify that many people authorized to access assisted suicide on the basis of emotional suffering have found the support, compassion, and help they needed through their death preparation and that this process paradoxically made them change their minds (Appel 2007; Engelhart 2021; Friesen 2020; Gandsman 2018b; Stefan 2016). In the compelling documentary 24 and Ready to Die, Emily, a physically healthy twenty-four-year-old Belgian woman suffering from psychological distress, recounts that through the support of her friends and family and the preparation for her assisted suicide, she found the desire to continue to live, at least for a while (she would die by euthanasia two years later). She says, “Without the option of euthanasia, years of suffering would have been compounded by a gruesome, lonely death. I would have killed myself” (The Economist 2015). Emily is not alone in testifying that being able to voice her desire to die and to be listened to and respected in that wish ultimately helped her go on living. In a short 2017 film titled I Want to Kill Myself, artist/scholar Vivek Shraya recounts how she managed to survive by breaking the silence:
Saying I want to kill myself felt like the first time I wasn’t lying to myself or to you.
Or pretending. For myself or for you.
Saying I want to kill myself made my pain explicit.
Saying I want to kill myself to the people who love me meant I was shown an immediate and specific kind of care that I desperately needed.
Saying I want to kill myself kept me alive. (emphasis in the original)
Attempting to destigmatize (assisted) suicide and have it recognized as one viable option among others may paradoxically help suicidal people find solutions other than suicide on their exploratory journey of life and death. Simultaneously, a harm-reduction approach may allow a small number of suicidal people who are determined to die to be accompanied while preparing for and completing their deaths. Either way, my suicide-affirmative approach insists on building relationships with suicidal people, caring for and supporting them throughout their journey. A suicide-affirmative approach could possibly save more lives than current prevention strategies, which are clearly failing suicidal people who complete their suicide without reaching out to prevention services. In sum, this approach proposes an “ethics of living” with suicidal people while they are making their ultimate decision.
5.3. Potential Objections to a Suicide-Affirmative Approach
My proposal to combat suicidism and support suicidal people by using a suicide-affirmative approach, which involves the possibility of accompanying people during their potential assisted suicide, elicits reactions and objections that cannot be dissociated from the context of biopower, biopolitics, healthism, sanism, and suicidism in the society in which we live. In this subsection, I focus on ten potential objections to a suicide-affirmative approach. These objections are informed by intellectual and political positions and “visceral” affects, emotions, and fears and have been shared with me by people who have read/heard my ideas on (assisted) suicide in various venues. While I believe that these concerns are legitimate, I demonstrate that many of them rely on underexamined presumptions, unfounded fears, or a lack of complex understanding of my position. This list of objections and responses does not pretend to be exhaustive. While much more could be said, I hope that these short answers deconstruct some of these concerns and will spark conversations about the eventual feasibility and applicability of my approach.
Objection 1: Why is it necessary to provide support in the form of assisted suicide when anyone can complete suicide on their own?
One common reaction I receive when discussing the importance of offering assisted suicide to suicidal people is the argument that nothing prevents them from completing their suicide. In other words, people may decide to end their lives at any moment and by any means. While true for many people, this argument does not take into consideration the reality of some disabled/sick/ill/older people who, for various reasons, do not have the capacity or the access to the means to end their lives. Living in an institutional setting, as is the case for many of these populations, makes it very difficult to have privacy for many activities, including romantic relationships and sexuality. This is also the case for incarcerated people. The same applies to suicide; if anyone can enter your room at any moment, if you are under constant scrutiny and surveillance by the institution’s personnel, it becomes difficult or, in some cases, impossible to complete suicide.
Aside from the ableist/sanist/ageist components of this objection, which do not take into consideration some of society’s most marginalized people, this objection is also problematic in its individualization of issues that are social and political. Many activists in social movements, such as the disability rights or disability justice movements or the trans, queer, or anti-racist movements, argue that if some suicidal people want to die, they should be left to fend for themselves and should not be helped (Coleman 2010, 2018; Thom 2019). When compared to the support we offer other marginalized groups within social movements, it seems not only contradictory but also, quite frankly, cruel to dismiss the violent, lonely, harsh means that some people in our marginalized communities are forced to use to end their lives.
In addition, as previously discussed, completing suicide is not easy, and support might be needed. Not only is completing suicide difficult, but the somatechnologies of life permeate all discourses, institutions, practices, and interventions to prevent suicides from happening. In an incisive answer to the question “Who is stopping you from killing yourself?,” Susan Stefan (2016, 55) says, “The government is, acting through the police, the ambulance, the emergency department, mental health professionals, the courts, and the entire apparatus of involuntary detention and treatment in this country.” In sum, the suicidist system and its mechanisms deter and prevent people from completing suicide—hence the need to support suicidal people.
Finally, it is necessary to support assisted suicide because, like most people, suicidal people would prefer not to die alone in atrocious conditions (Stefan 2016). Empirical studies show that in countries where assisted suicide is offered solely on the basis of mental/emotional suffering, people believe that dying in a supportive environment would be preferable to dying under lonely and difficult circumstances. As Phoebe Friesen (2020, 38) explains, “A qualitative analysis of people who requested assistance in dying in Belgium for psychological suffering found that ‘suicide in general was considered as painful, horrific and humiliating, but still evaluated as a possibility by patients whose euthanasia requests could not be granted. However, dying in a caring environment, surrounded by loved ones, was very much the preferred option.’”
Objection 2: Isn’t it dangerous to endorse your suicide-affirmative approach when we have no proof of its efficacy?
A second objection raised throughout the years is that my argument about the potential life-saving effects of a suicide-affirmative approach is based on pure speculation rather than on scientific evidence. What is even more worrisome for some is that my hypothesis that a suicide-affirmative approach would save more lives than do current suicide prevention strategies is risky and could even lead to more deaths. Researchers studying suicide rates in relation to assisted suicide regulations conclude that no empirical evidence exists to support the claim that making assisted suicide (or euthanasia, as they call it) accessible for people with “severe” mental illness would decrease suicide rates (Gorsuch 2006). Scholar Theo A. Boer (2017, 6) argues, “The assumption that euthanasia will lead to lower suicide rates is not supported by the numbers.” Additionally, scholars Katrine Del Villar, Lindy Willmott, and Ben White (2020) conclude that many of the cases of what they call “bad deaths”—that is, suicides—would have happened regardless of the availability of legislation on assisted suicide, since many people are not eligible based on current criteria. In sum, people legitimately wonder how my approach would not cause more harm if it were adopted.
I have three responses to this objection. First, I have never pretended and will never pretend that my hypothesis that a suicide-affirmative approach might save more lives is supported by scientific evidence. Quite the contrary: Similar to other radical approaches, such as abolitionist perspectives, it is a new and radical approach that is untested, and there is no way of knowing what would happen were it to be implemented. Most importantly, as mentioned throughout this book, one main argument I defend is about denouncing suicidism and the violence suicidal people suffer under current suicidist regimes. My primary goal is to seek better accompaniment for suicidal people, not to save lives. As discussed in the Introduction, when facing such a radical transformation, we need to accept that we will not know in advance how everything will unfold; it is part of the dis-epistemology abolitionist activists/scholars such as Ben-Moshe (2020) invite us to embrace.
Second, decade after decade, we face a sad reality: None of the initiatives and strategies are working, at least not with people who completed their suicide. No one can deny this reality. When you repeatedly try, using various methods, to obtain results but are unsuccessful, you must ask: How can we think differently? How can we adopt strategies outside the box that have never been tried? In other words, we don’t have much to lose because we are already “losing” the people determined to die. I prefer to ask: What do we have to gain? What possibilities would open up if we were to drastically rethink our approach to suicidality?
Third, the conclusion that current laws allowing assisted suicide do not lower suicide rates and do not prevent “bad deaths” is simply erroneous because those laws are specifically designed, as demonstrated in Chapter 4, to exclude suicidal people. How can laws that help disabled/sick/ill/Mad/older people die affect the rates of suicidality for suicidal people? It cannot be determined whether laws on assisted suicide would decrease suicide rates among suicidal people until these laws include suicidal people. Until a suicide-affirmative approach is implemented, with a complete destigmatization and decriminalization of suicidality and support for assisted suicide for suicidal people, confirming my hypothesis is impossible. However, it is also impossible to confirm that such an approach would be ineffective or damaging.
Objection 3: How can you ensure that suicidal people’s decisions are truly autonomous?
As discussed in previous chapters, based on sanist conceptualizations of mental illnesses, some proponents of the medical or public health models of suicidality believe that suicidal people are irrational, nonautonomous subjects. I have also demonstrated that most activists/scholars who adhere to the social or social justice models of suicidality question the competency of suicidal subjects, believing that undue influences coming from interpersonal relationships (e.g., family pressures) or oppressive systems bias decision-making capacity and autonomy to make informed decisions.11 In other words, regardless of the model endorsed, suicidal people are not perceived as competent and agentive subjects to make important decisions about their lives and deaths. I hope that by now readers have been convinced, through my mobilization of scholarship from the anti-psychiatry movement and Mad movement/field of study, that labeling suicidal people as “crazy” and “irrational” and preventing them from exercising their autonomy and self-determination are part of a sanist system and its insidious forms of violence. The argument regarding the irrationality of suicidal people is sometimes even endorsed, as we have seen, by activists/scholars in anti-oppression circles. For example, Kai Cheng Thom (2019, 45) argues that while some people, like me, contend that it is ableist/sanist to deny suicidal people self-determination, the argument could be turned upside down; it is ableist/sanist to say that people are always rational:
This is where the anti-ableist facet of the “support suicide” argument breaks down as well—it may be ableist to dismiss someone’s rationale for dying, but it is equally ableist to expect that everyone in a crisis of pain will be able to express or even know their needs in a perfectly linear, logical way. It is ableist to assume that simply asking for consent to intervene once, or even twice, is sufficient to determine whether someone might want or need help.
My suicide-affirmative approach takes potential mental or emotional crises into consideration; indeed, it would not be beneficial for suicidal people to have their death supported through assisted suicide while they are in the middle of a crisis that momentarily impairs their capacity to make informed decisions. But such moments of crisis are temporary. Additionally, the process of accompaniment I propose, founded on anti-ableist/anti-sanist perspectives, would preclude a rushed decision and would carefully look at the undue influences stemming from personal relationships and structural factors that might shape the decision-making process. Accompaniment for preparation for an assisted suicide would necessarily be a multifaceted process, taking place over the course of a few months in concert with a professional team and the person’s support network.
Activists/scholars have also abundantly discussed various notions of competence and autonomy and how social determinants considerably influence our decisions about our health, including the decision to stay alive or to die.12 I wholeheartedly embrace the notion of relational autonomy, in opposition to the individualist and liberal visions of autonomy put forth by many philosophers, bioethicists, and right-to-die proponents. I am also aware of the impacts of oppressive systems on the suicide rates of marginalized groups. Chapters 2 and 3 document that the desire to die cannot be conceptualized without taking into consideration heterosexist, cisgenderist, ableist, and sanist violence at a structural level and their manifestations at an interpersonal level. But that portrait remains incomplete, as demonstrated throughout this book, if we do not take into consideration one of the central oppressive systems when it comes to suicidality: suicidism.
While I concur that sociopolitical forces—some would say “suicidal regimes” (Button 2020, 87)—exist that contribute to the overrepresentation of some marginalized groups in statistics on suicidality or, in other words, push people to die, what is often kept hidden, and what this book reveals, is that simultaneous forces, or somatechnologies of life, exist to push suicidal people to stay alive. A truly intersectional analysis that would take into consideration not only one, two, or three oppressions in relation to suicidality but also suicidism would reveal a different picture. If some elements affect competence and autonomy and influence suicidal people to want to die, I argue that simultaneously, just as many forces push them in the other direction. While various -isms can be internalized (through pressure from significant people and from society) and lead to suicidality, suicidism can also be internalized and exerted by loved ones and society. In sum, marginalized groups are trapped in a complex web of interwoven forces of necropolitics and biopolitics, and a relational conceptualization of their autonomy must be thought of in relation to not only some oppressive systems, such as cisgenderism and ableism, but also other systems, such as suicidism and compulsory aliveness. In our social movements/fields of study, if we stand for the right to autonomy and self-determination for important decisions (e.g., reproductive issues or trans issues), we cannot promote self-determination only when it fits our vision of the world and play the cards of irrationality, alienation, incapacity, and biased decision-making when it conflicts with our values or preferences.
Objection 4: Would marginalized groups be overrepresented in statistics on assisted suicide?
One crucial worry about current forms of assisted suicide founded on an ableist/sanist/ageist and suicidist ontology is the overrepresentation of marginalized groups in statistics on assisted suicide. While I agree with the critique that current laws are fundamentally ableist/sanist/ageist in targeting only “specific populations,” in countries in which some forms of assisted suicide are allowed, empirical evidence shows that mostly privileged people have access to it (Davis 2013b; Engelhart 2021; Stefan 2016). In the Canadian context, some legal scholars, inspired by feminist thinkers, have also suggested that empirical evidence points to the fact that those who die through assisted suicide belong to the most privileged groups. For example, Jocelyn Downie (2020, 25) explains:
According to a recent Ontario study, “Recipients of MaiD were younger, had higher income, were substantially less likely to reside in an institution and were more likely to be married than decedents from the general population, suggesting that MaiD is unlikely to be driven by social or economic vulnerability” (Downar et al. 2020). This is all consistent with the experience in the other permissive jurisdictions that have found that, if anything, MaiD is disproportionately accessed by people of power and privilege (Carter 2012, para. 26; Truchon 2019, para. 452). One thing we do not know, yet feminist philosophy [ . . . ] would tell us to pursue, is whether these results flow from there being barriers to access for marginalized populations.
Downie is not the only one to have pointed out the structural barriers to accessing assisted suicide. As discussed in Chapter 4, it would seem logical that if the most marginalized groups in our societies encounter structural hurdles to accessing health care and social services, then access to services to end their life could also be compromised. Such barriers may in part explain the overrepresentation of dominant groups in the statistics.
In a similar way, some people might argue that opening the gates of assisted suicide to everyone, as my suicide-affirmative approach proposes, could potentially lead to the overrepresentation of marginalized groups in the demand for assisted suicide. After all, if many marginalized people struggle with suicidality, and if assisted suicide were made universally available and structural barriers (-isms) combatted to make assisted suicide truly accessible, wouldn’t all those who want to die because they are mistreated in our society seek access? My honest response is yes, this is a possibility. Except for rare exceptions, people usually want to die because they are profoundly unhappy. This state could come from a variety of factors: from genetics, mental illness, misfortunes, and personal traumas, but also, and often, I believe, from social and political factors. However, as I have argued in this book, we should not establish hierarchies between good and bad reasons for wanting to die, and taking suicidal people hostage and keeping them alive while we lead the revolution is neither right nor ethical. A person who has articulated a stable desire to die should be supported, regardless of the source of their despair. That being said, I sincerely hope that my approach, which consists of working tirelessly on two fronts at the same time—namely, ending all structural forms of violence and supporting suicidal people through a suicide-affirmative approach—would contribute to decreasing the number of marginalized people who want to die as a result of not having decent living conditions and decent suicide interventions. In that sense, my approach responds to the fear regarding the overrepresentation of marginalized groups in assisted suicide because, contrary to all arguments for the right to die that focus on individual rights but do not anchor their analyses in an anti-oppressive approach invested in structural change, my dual approach addresses the systemic factors at play in the lives of marginalized groups when it comes to suicidality.
Objection 5: Are we sending the wrong message to marginalized people and suicidal people by telling them that we support their assisted suicide?
As discussed in Chapter 3, many disability activists/scholars have stated that laws on assisted suicide send the wrong message to disabled/sick/ill people—namely, that their lives are not worth living. Similar concerns have been expressed in relation to other groups and their suicidal ideation. For example, in a self-critical reflection on earlier thoughts on suicide she shared on social media, Thom (2019, 43) expresses regret about wanting, earlier in her career, to destigmatize suicidality, particularly in the case of marginalized communities. In such heterosexist, cisgenderist, racist, classist, ableist, or sanist societies, which endorse a culture of disposability regarding marginalized groups, supporting their suicide is, from this perspective, wrongly sending the message that their lives are not valuable. As scholars Anita Ho and Joshua S. Norman (2019, 53) mention, “If one’s sociohistorical and economic contexts are part of the reason for despair, it would seem morally perverse to suggest that compassionate response to that suffering demands access to PAD [physician-assisted dying] rather than opportunities for sustainable living conditions.”
I do not believe that my suicide-affirmative approach would send the message to marginalized groups that their lives are not worth living. Quite the contrary: My approach is centered in the recognition that the lives of the most marginalized are worthy, that current laws and regulations on assisted suicide are violent and cast these lives as unworthy, and that an anti-suicidist approach should necessarily translate into better living conditions for many marginalized groups, including suicidal people. The message sent by my suicide-affirmative approach aims to reinforce the messages, values, and principles sent by social movements to marginalized groups: We want to listen to what you have to say, we want to create safer spaces for you to discuss your experiences and realities, we value and believe your testimonials, we recognize your expertise regarding your reality, we cherish your autonomy and self-determination, and we are there to support you regardless of the decisions you make about yourself. The message underlying my suicide-affirmative approach is that everything should be done to combat the multiple -isms that members of marginalized groups face in their daily lives; however, if they still experience a too-high level of distress and are too tired to continue living, then they should not have to leave the world in the same way they have sometimes lived their lives, marked by loneliness, rejection, stigmatization, lack of support, isolation, and violence. The message behind Undoing Suicidism is that all marginalized groups count and that the same recognition, respect, and support should also be given to suicidal people.
Objection 6: Isn’t it anti-revolutionary to grant suicidal people the right to die based on suffering due to sociopolitical violence?
This book makes clear that a logic of disposability regarding people who do not fit the dominant norms and structures is at work in our societies. Therefore, supporting (assisted) suicide for those unwanted subjects represents, to many, the worst manifestation of this disposability culture. Thom (2019, 45) reminds us:
And in terms of considering trans women’s suicides within transmisogynist social system, I do not believe that “supporting the agency of suicide” is actually a legitimate refutation of that social system. Rather, it is the ultimate expression of disposability culture. It allows us to disguise inaction in the face of mass suffering and death in a pretense of compassion and radical politics. It is not radical to “support” trans women dying when we are already being murdered regularly. It is not revolutionary to simply accept that society is so terrible that trans girls might as well kill ourselves.
Similarly, while praising some of the values of my anti-suicidist framework and suicide-affirmative approach, Ian Marsh, Rachel Winter, and Lisa Marzano (2021, 13) nonetheless conclude that my approach does not lead to a “genuine form of liberation” of those targeted by oppressive systems.
The issue with this objection is that some of these authors, who are focused, for example, primarily on trans issues, assume that what I propose for ending cisgenderism is assisted suicide for trans people. From this perspective, my position may appear quite anti-revolutionary and lead to this logic of disposability. However, to combat the oppression trans people face, we must fight cisgenderism as well as interlocking systems of oppression, such as sanism and suicidism, to name only a few. In other words, my solution for ending trans people’s suffering is not to offer a quick exit through assisted suicide. Instead, resources and energies must be dedicated to ending the structural violence they face to reduce suicidality in these communities; at the same time, we also need to take into consideration how other forms of oppression, such as suicidism, are at play and remain invisible in the ways we treat trans suicidal people (and other suicidal people). Working to eliminate suicidism involves listening to suicidal people, not negating their autonomy and self-determination, and supporting, as we are trying to do with other marginalized groups, their needs, claims, and demands without delegitimizing their voices under the pretext of irrationality or political alienation.
In sum, revolution(s) does not happen in a vacuum, and intersectionality has taught us that no one should be left behind by the revolution; wanting to liberate one group at the expense of another is not an acceptable solution and, most importantly, fuels a misconception about the intertwined effects of oppression. In other words, offering suicide as the solution to combating cisgenderism is, indeed, anti-revolutionary (and not what I propose), but I would say that preventing and opposing suicide to liberate trans communities is also anti-revolutionary in its tunnel vision, which forgets suicidal people, their oppression, and their needs. The liberation of trans people (and other marginalized groups) and suicidal people are not mutually exclusive.
Objection 7: Does medicalizing assisted suicide give too much power to the medical-industrial complex?
Another objection I encounter is regarding concerns over giving too much power to the medical-industrial complex through various forms of assisted suicide. Tania Salem (1999) and Thomas F. Tierney (2006, 2010, 2021) rightly point out that laws on assisted suicide reinforce the legitimacy of physicians and the state in deciding who should be allowed to die. These laws are not truly giving individuals more liberty, autonomy, or self-determination but only an appearance of choice that is highly regulated by medico-legal biopolitics in a biopower apparatus. As Salem (1999, 24) states:
The insult to autonomy is not exerted through repression [ . . . ]. Rather, it is exercised through [ . . . ] the subordination to medical scrutiny of this event and the person making the request. The “patient” is subjected to observation, examination, and inquiry to confirm the “rationality” and “voluntariness” of his or her request. Thus medicalizing (assisted) suicide jeopardizes autonomy not only when the patient’s request is denied for one reason or another. Requiring that the patient submit to medical surveillance is, in itself, an outrage to autonomy.
I concur with Salem’s and Tierney’s analyses. I am also particularly sensitive to this objection since I have heard it from trans people regarding trans care, when advocating for an alternative delivery model of health services. The medical-industrial complex acts as a gatekeeper against trans people, and the organization of trans care through alternative venues, such as peer-support groups, community organizations, and DIY methods, often offers much safer spaces for trans people to explore their gender identity and to transition than does the current health care system or social services. The same would likely be true for suicidal people if we adopted a suicide-affirmative approach. In that sense, assisted suicide delivered by the health care system and social services and regulated by the state risks the same co-optation. Therefore, I believe that we would need to work on multiple fronts simultaneously, as we do for trans recognition, in terms of getting official support from the state and medical system and in terms of developing our own networks, community organizations, and groups to better serve our communities. Unfortunately, just as trans people who wish to pursue a medical transition find that it is difficult or impossible without the support of the state and the medical-industrial complex, the same is true for suicidal people: The know-how and prescriptions for peaceful death are in doctors’ hands. Therefore, we must know how to navigate these tricky waters and insist on decentralizing the power of medicine/psychiatry for those who need to interact with the health care system and social services for various reasons (e.g., pregnancy, transition, assisted suicide, or general health care). In sum, we must ask: Does the problem reside in medicine itself or in the ways medicine is practiced? My answer is that if the medical system has major problems, maybe the goal should not be to avoid the medical system altogether but to rethink the way medical care is delivered.
Objection 8: Will authorizing assisted suicide be a slippery slope and lead to an increase in deaths?
The slippery-slope argument has been discussed extensively in debates regarding existing forms of assisted suicide. I will not repeat these debates since other authors have already done so.13 In the same vein, my suicide-affirmative approach may raise some concerns regarding the “romanticization” of suicide. As a journalist once asked me, “Might your approach make death appear peaceful and painless and therefore increase the number of deaths of people who would otherwise have been dissuaded from suicide by the fear of pain and ‘botched’ suicide?” Many people think that depathologizing and destigmatizing suicide is dangerous (e.g., Hecht 2013). As Thomas Joiner (2005, 43) says, “Any analysis that encourages suicidal behavior in any way—particularly in ways that romanticize or glorify it, or make it seem easy and normative—has potential negative consequences for public health.” Additionally, the ideas of a slippery slope and “contagion” are often used as a rationale against many practices that counter dominant norms and structures, such as various sexual practices or gender identities.
I have three responses to this concern. First, while my suicide-affirmative approach would destigmatize suicide, it would not promote it as the only option or the best option but simply as one option among others. As I have mentioned, the suicide-affirmative approach is life-affirming and death-affirming. My proposal does not glorify suicide but rather endorses a harm-reduction approach. I believe that many suicidal people would choose any other available option to avoid suicide and that most suicidal people would not, in my opinion, be happy to complete their suicide; it is, rather, their last recourse to managing their despair. My position is pragmatic: If the person believes that other options have not worked, assisted suicide would be one way to relieve the despair/distress after considering all the pros and cons of that decision. The harm-reduction approach I suggest would allow us to accompany the suicidal person in making an informed decision, to present them with multiple options, and to reduce the potential harm experienced by them or their relatives and friends if they decide to go ahead with their decision to die.
Second, my suicide-affirmative approach does not make death appear to be an easy option—quite the opposite. The accompaniment I envision from a suicide-affirmative approach involves careful reflection and attentive preparation for one’s death. Preparing for one’s death is not an easy process, and perceiving my suicide-affirmative approach as a quick and easy path is an inexact representation of that process.
Third, without returning to arguments discussed earlier in this chapter, a suicide-affirmative approach would allow us, for the first time, to reach out to people who are seriously considering dying by suicide but who would otherwise remain silent in completing their death plans. Instead of seeing a potential increase in deaths by (assisted) suicide, I envision a potential decrease in people dying by (assisted) suicide since they would have the opportunity, for the first time, to finally reach out for help, support, and connection instead of completing their suicide without having discussed their plans. The support suicidal people would receive through this process might be life-saving for many. And those determined to die would do so, regardless of the existence of my suicide-affirmative approach, as our statistics on suicide demonstrate. Therefore, I do not believe that my approach would increase the number of deaths or provoke a phenomenon of “contagion”—quite the contrary.
Objection 9: Is it asking too much of family members and friends to support a suicidal person in their assisted suicide?
Many people have told me that they understand and agree with many of my arguments but have an affective blockage when it comes to potentially accepting the assisted suicide of their partner, parent, child (at age of majority), or friend. I am very sympathetic to this concern; if my partner wanted me to accompany her during her assisted suicide, I would have a lot of difficulty letting her go. It is part of any mourning process to have trouble letting go of the people we love (be it through death, separation, or other life circumstances). I agree that any loss, including through death, is terribly painful. It is normal to have a hard time accepting the death by suicide of someone we love because it involves loss. Nevertheless, finding it hard to lose someone is not a valid reason to force them to stay in our lives (Arcan 2008; Horncastle 2018). This argument applies to relationships and deaths. Being in love with someone and wanting to spend the rest of your life with them does not entitle you to force them to stay with you. While we would find the situation abusive if someone forced their partner to stay in a relationship because a separation would cause them pain, sorrow, sadness, anger, or mourning, we find it less problematic, due to the suicidist system, to force someone to stay alive simply because we want this person in our lives.
A suicide-affirmative approach that would help family and friends accompany someone through an assisted suicide would likely be less traumatic in the medium and long term than an unexpected suicide. As I have discussed, this approach would allow the person’s support network to have a better understanding of the reasons for the (assisted) suicide, to support the person to the best of their abilities, and to have a better sense of closure through death preparation. Family and friends would also be less traumatized if they did not have to discover a body that had died through violent methods. I often ask my interlocutors: Would you prefer to come home and find your partner dead without having had time to discuss their desire for death, or would you prefer to be there for them; to listen to their reasons for wanting to die; to offer them the support, help, and love they need; and, eventually, to know that their death was not a violent event but a deeply sad yet loving moment you shared with them? If I ask myself this question, my response is clear: I would prefer the second option. I might be alone, but I do not think that I am.
Objection 10: What about hope?
Hope is probably the leitmotiv of all preventionist discourses and intervention strategies, regardless of the model of suicidality. Compulsory aliveness is fueled in part by the hope for miracle medical treatments, such as new antidepressants, new forms of psychotherapy, or global sociopolitical change to improve the lives of marginalized people. Individuals, mental health, and environments may change and improve, so why give up hope and resort to a permanent solution for temporary problems, as many people ask in suicide prevention campaigns? Friesen (2020, 37) notes that hope is probably one of the most important factors in the differentiation between suicide and assisted suicide, with the former associated with hope for improvement and the latter linked to a hopeless irremediable condition. The notion of hope is central, for example, in Thom’s book. It is the key message that she seems to want to impart to her trans sisters of color (2019, 142):
But for now, something keeps me here: hope, I think, or maybe love. I wonder, can you have hope, or love, without faith? The faith that things will get better, that we will live long and happy lives, that some benevolent force in the universe will give us better endings? I think perhaps we can. What I hope for is to live as brilliantly as the mothers and sisters I’ve never met.
While I am certainly moved by Thom’s call for hope and recognize that hope is central to my work as an activist/scholar who fights for a world where marginalized groups will thrive instead of survive, we cannot impose our hopes on others. This rule is particularly true if our imposition would force them to do things to which they did not consent. I may hope that my friend who is a Jehovah’s Witness would transgress the rules of her faith about the blood transfusion she needs to save her life, but my hope that she chooses one path instead of another is not a reason to impose my will. Imposing our will, hopes, and wishes on others is unacceptable, even when it comes to health care decisions that are a matter of life and death. Paradoxically, while it is recognized in most countries that imposing a blood transfusion on my friend would be a violation of her religious rights and values, the same respect is not attributed on the basis of suicidality; instead, suicidality becomes a justification to intervene against a person’s will and needs. While not unequivocally negative, hope is definitely an important component of somatechnologies of life that force suicidal subjects to stay alive despite their desire to die. And hope is probably, in this specific case, one of the strongest incarnations of cruel optimism: It preserves “an attachment to a significantly problematic object” (Berlant 2011, 24)—that is, the hope for a better future. With the promise of better days to come through medical/psychological or sociopolitical cure, hope unfortunately fuels the suicidist violence experienced in the here and now by suicidal people.
5.4. Thanatopolitics of Assisted Suicide as an Ethics of Living
While Kafer (2013, 2–3) does not have suicidality in mind when she offers her thoughts on crip futurity and queer and crip politics, in light of what I theorize in this book, the word disability in the following passage could almost be replaced by the term suicidality:
If disability is conceptualized as a terrible unending tragedy, then any future that includes disability can only be a future to avoid. A better future, in other words, is one that excludes disability and disabled bodies; indeed, it is the very absence of disability that signals this better future. The presence of disability, then, signals something else: a future that bears too many traces of the ills of the present to be desirable. In this framework, a future with disability is a future no one wants [ . . . ]. It is this presumption of agreement, this belief that we all desire the same futures, that I take up in this book. [ . . . ] I argue that decisions about the future of disability and disabled people are political decisions and should be recognized and treated as such. Rather than assume that a “good” future naturally and obviously depends upon the eradication of disability, we must recognize this perspective as colored by histories of ableism and disability oppression. [ . . . ] What Feminist, Queer, Crip offers is a politics of crip futurity, an insistence on thinking these imagined futures—and hence, these lived presents—differently. Throughout the course of the book, I hold on to an idea of politics as a framework for thinking through how to get “elsewhere,” to other ways of being that might be more just and sustainable. In imagining more accessible futures, I am yearning for an elsewhere—and, perhaps, an “elsewhen”—in which disability is understood otherwise: as political, as valuable, as integral. (emphasis in the original)
As is the case for disability, suicidality “is a future no one wants,” a presumption commonly shared that is anchored in suicidism and compulsory aliveness. Similar to the way Kafer aims to imagine a crip futurity,14 I hope that this book helps readers imagine a suicidal futurity. By suicidal futurity, I mean a future in which suicidality ceases to be only a problem to be fixed and cured, an unacceptable solution, an option out of reach, the ultimate failure of life. Imagining a suicidal futurity opens our minds to envision suicidality in all its complexity: its sadness, ugliness, and darkness, but also its more productive and constitutive components, as per a Foucauldian formulation. Indeed, suicidality shapes many of us and influences our lives; it lives inside us, sometimes providing us with peace of mind and respite from the despair we experience. In Simone Fullagar’s work (2003, 296), one of the suicidal participants refers to suicide as “a place,” a safe place reached as a coping mechanism to have a mental and emotional exit from the cruel world. As Ann Cvetkovich demonstrates that political depression may also be filled with joy and hope, suicidality may also be filled with joy, hope, and life. As a coping mechanism for many, chronic suicidality offers an escape. When we start seeing suicidality not only as a bad thing to avoid but as a complex phenomenon to explore, we allow ourselves to listen to testimonials currently smothered or dismissed through suicidist epistemic injustices. Envisioning a suicidal futurity is not only a transitory political battle for people who will die by (assisted) suicide but also a battle for many suicidal people who will most likely continue to live. Suicidal futurity opens up a space for all those who wonder about their attachment to life and want a social and political venue to discuss these thoughts. When we start understanding suicidality differently, as Kafer proposes regarding disability—in other words, as something “political, valuable [and] integral” to life—we can see the relevance of a thanatopolitics or politics of death that concerns living suicidal individuals rather than only dead ones or the dead-to-be.
At first, a thanatopolitics seems incompatible with an ethics of living, and my notion of a suicidal futurity may seem to be an oxymoron. This interpretation would be correct if, for example, I were endorsing the original theorizations of the “thanatopolitical” logics underlying some political strategies, such as death camps, as discussed by Giorgio Agamben (1998), in which some lives considered unworthy (“bare life”) are targeted to die. I am less interested here in considering the notion of thanatopolitics and its lethal consequences as proposed by Agamben, work that has been done by other scholars, than in rethinking the notion through its productive aspect, as Stuart J. Murray (2006, 2008) proposes. For Murray (2018, 718), thanatopolitics and biopolitics are deeply intertwined:
Biopolitics not only occasions but also tolerates a certain threshold of death as its modus operandi [ . . . ]. Such a perspective would call into question the implicit decisions, and covert cultivation of death, in the biopolitical logics that determine and distinguish those who are worthy of life, those who shall be made to live, from those who are permitted to perish.
Using the example of suicide bombers, Murray contends that thanatopolitics “is both a response and a resistance to biopolitical power” (2006, 195; emphasis in the original), since suicide literally annihilates the potential exercise of biopower and its surveillance, regulation, and control over subjects.
For me, a thanatopolitics is not only or primarily a politics to deliver death but a politics that proposes to politicize and historicize death and the tension between some people’s desire for life and for death. A thanatopolitics is not antithetical to life-affirming perspectives. In the spirit of queer death studies (Petricola 2021; Radomska, Mehrabi, and Lykke 2019), which seek to theorize the sociopolitical aspects of death in a cross-pollination between queer and death studies (thanatology), a politics of death is one in which death may also be reclaimed and resignified. Like the queer or crip politics envisioned by Kafer and other activists/scholars, thanatopolitics could become a social and political horizon for understanding death, including death by (assisted) suicide. In light of the major failures of the right-to-die movement to pursue a radical agenda guided by social justice for marginalized communities, the thanatopolitics I propose is an alternative with the potential to offer reflections and a political agenda for queering, transing, cripping, and maddening the right to die and (assisted) suicide. Thomas Szasz (1999, 119) says, “Dying, after all, belongs to the living, not to the dead.” Thanatopolitics, in that sense, may represent an ethics of living for all people theorizing and advancing justice in death, including justice for suicidal people.
What is detrimental to disabled/crip/Mad people, according to Kafer, is the lack of futurity and imposition of a potential singular future in which a part of themselves—their disability/madness—is eradicated. The same is true for other marginalized communities pushed by norms and structures toward normalization and assimilation in dominant systems of intelligibility. In other words, the futurity they dream about is made inaccessible and undesirable. With respect to trans people seeking trans-affirmative health care, some authors, such as Victoria Pitts-Taylor (2019) or Ruth Pearce (2018), demonstrate that this blocked or delayed futurity is often a trigger for despair and, in some cases, suicidality. As Pearce (2018, 153) illustrates, “In these examples, an anticipated future has effectively been denied, and there is typically no indication of when the continued waiting time might end. [ . . . ] Participant experiences of suicide ideation further demonstrate the importance of anticipation to trans patients and their communities. For participants who consider suicide, the possibility of a transitioned future can offer an alternative.” Just as trans-affirmative health can offer well-being to trans people, providing suicide-affirmative health care might open up a future for suicidal people. Recognizing that a crucial part of suicidal people—that is, their suicidality—has a future that could exist, be validated, and be chosen through a radical thanatopolitics might, paradoxically, help people cultivate a desire for living. The political alliances between suicidal people gathered around a thanatopolitics aiming to eradicate suicidism and deconstruct compulsory aliveness, the injunction to live and to futurity, might also be an opportunity to break the isolation many suicidal people experience. In sum, as for many trans people, being allied with people in their communities and working toward a common future could, for some suicidal people, assuage an important angst that obscures their will to live. A thanatopolitics would open up all these possibilities in terms of suicidal futurities.
While Chapter 4 highlights the limitations of right-to-die discourses on assisted suicide, Chapter 5, through a queering, transing, cripping, and maddening of assisted suicide, proposes an alternative to the current right-to-die movement and its ableist/sanist/ageist/suicidist politics: a thanatopolitics, or politics of death, anchored in an anti-oppressive approach and sensitive to suicidal people’s needs, claims, and voices. The thanatopolitics I have in mind permits suicidal futurities to exist, opening not only a space in which death by (assisted) suicide may occur but also a space in which to openly and honestly discuss what it means to live with a desire to die. In that sense, this thanatopolitics is a politics not only for the dead or the dead-to-be but for all people interested in fighting for social justice when it comes to death, suicide, and assisted suicide. In that sense, this thanatopolitics represents an ethics of living, while reflecting on death and dying, and should be anchored in the queercrip model of (assisted) suicide I propose here, an alternative model to those founded primarily on prevention and the eradication of suicidality. By complexifying and rethinking our visions of (assisted) suicide, the queercrip model allows us to avoid thinking that social justice and anti-oppressive approaches are antithetical with a right to die through (assisted) suicide. The queercrip model is also at the foundation of a new approach to suicidality, a suicide-affirmative approach characterized by its focus, among other things, on the voices and needs of suicidal people, on their lived experiences, on their experiential expertise, and on their autonomy and self-determination in relation to their decisions regarding life and death. Among the ten principles guiding my suicide-affirmative approach, which could be deployed in multiple spheres, including suicide-affirmative health care, is the harm-reduction philosophy applied to suicidality as well as the informed consent model of care applied to assisted suicide.