The Cliffs of Tojimbo

At Japanese Cliffs, a Campaign to Combat Suicide
Martin Fackler, New York Times (December 17, 2009)

Tojimbo Cliffs

“I will continue until the government finally gets its act together and takes over,” he said. “I can’t let their inaction cost another precious life.”

Japan has a long history of suicide. And nowhere is this cultural phenomenon felt more keenly than at the cliffs of Tojimbo, a popular tourist destination, on Japan’s western coast. This scenic and treacherous spot has the grim distinction as being one of the best known places to kill oneself in Japan.

Japan’s suicide rate is an astonishing three times higher than that of the U.S. In 2003, a record 34,427 people committed suicide in Japan and this year is on track to approach that number. Due to the global financial crisis and Japan’s long economic decline, suicide has become an “honorable” solution in a place where depression is little discussed and very rarely addressed.

But there is one man who is trying to change all this, at least in his small (but arguably large) way. He is Yukio Shige, a retired policeman who has dedicated his days to trying to prevent people from jumping off Tojimbo’s cliffs. Mr. Shige has also organized over 70 volunteers who also help him patrol the cliffs, looking for the loners. Read the NYTimes article linked above for a profile of this good Samaritan.

I am truly in awe of his dedication to this mission. It is an amazing testament to the resolve of one man, determined to save lives, one conversation at a time. If I had a hero, Mr. Shige would be it.

Death + the Law Death Ethics Suicide

No Presidential Condolence for Soldier Suicide

A few weeks ago, various news outlets reported the story of Spc. Chancellor Keesling, an American soldier in Iraq who committed suicide. While incidents of suicide among soldiers who are currently active and those returned home is certainly newsworthy, the focus of this particular story was quite different. Although Mr. Keesling received a proper military burial, his family did not receive the standard condolence letter sent by the president, as is customary for fallen soldiers.

This didn’t sit well with the family. Was he not a hero too? Did he not serve his country honorably? Mr. Keesling’s family then found out the reality: there would be no condolence letter — it was a matter of policy. Incensed, Mr. Keesling’s father, Gregg, wrote letters to President Obama and Army Chief of Staff Gen. George W. Casey Jr. asking them to reconsider the policy. You can read the letter here.

An Op-Ed piece in Friday’s New York Times also addresses the issue, which looks at the notion that recognition of soldier suicide valorizes or venerates death.

I have mixed feelings on this issue. I can certainly see how a grieving family would want to have their son or daughter’s military service recognized and respected and how a letter from the president would help ease that pain just a bit. However, I also don’t think killing oneself is the same as dying in combat, getting killed by friendly fire or any other way while serving. It is a different kind of death — or so we are to believe — one that does not jibe with the heroic propaganda and selfless ideology of the military.

This does not mean that Mr. Keesling did not serve his country honorably or that he doesn’t deserve recognition somehow. But ultimately, it is Mr. Keesling’s family that will live with the pain of his death for the rest of their lives, and no letter is going to change that. For President Obama and other military officials, a condolence letter is just part and parcel of the war machine, or S.O.P (standard operating procedure) in military terms. Although the Administration is looking into their current policies surrounding condolence letters, suicide, for now, is not considered “honorable.”

I believe that focusing on the root causes of depression and supporting mental health efforts for military personnel is the best strategy — and will hopefully help lessen the number of suicides in the first place — and the pain for those left behind.

Death + Crime Grief + Mourning Suicide

The Rest in Pieces

This American Life: How to Rest in Peace
originally aired November 2, 2007.

This episode of This American Life re-aired yesterday, providing me a driveway moment (well… a snow-deranged street parking moment). If you missed it then or in 2007, have a listen online to these three stories exploring how the rest — the living left behind — find peace or stay in pieces.

Examining the emotional impact of the right to die, the last story is particularly striking. A growing old but generally healthy woman prepares herself and her family for her suicide because she fears suffering (and making her family suffer) the dementia that consumed her own mother. Her son is left in the horrible position of wanting to comfort his mother and respect her wishes while being sick with shock and grief about her oncoming death.

Death + the Economy Suicide

Stressed Out


In the U.S. and overseas, the recession is taking a toll. In addition to bodies stacking up at morgues and cemeteries in foreclosure, we can now add to the list the phenomenon of economy-induced, work-related suicides.

As reported in The Guardian and other news outlets, France Telecom is experiencing a rash of suicides that began in the beginning of 2008. Since that time, there have been 24 suicides and 13 attempted suicides among the company’s 100,000 employees. The cause? Work stress. You can also listen to the full story on today’s All Things Considered.

Stress-related deaths are nothing new. In Japan, the country has seen an increase in incidents of karoshi, which literally translates to “death from overwork.” However, karoshi differs from stress-related suicide in that the manner of death is attributed to heart attack or stroke. Government and business leaders have begun to acknowledge, albeit slowly, the problems associated with over-working and have started to implement programs that strive to achieve more of a work/life balance.

Death + the Law Death Ethics Suicide

New Assisted Dying Guidelines in England

Director of Public Prosecutions Publishes Interim Policy on Prosecuting Assisted Suicide
The Crown Prosecution Service (September 23, 2009)

Last week in England, the Director of Public Prosecutions, Keir Starmer QC, released new guidelines on assisted dying. The goal of these new guidelines is to give family members a clearer understanding of what is acceptable before the law when assisting a loved one to die. As the law currently stands in England and Wales, assisting another person’s suicide is against the law. I discussed what caused these new guidelines here.

Here, then, are the guidelines (which are not laws) which will be used to evaluate whether or not compassion was the guiding principal behind the assistance:

The public interest factors against a prosecution include that:

  • The victim had a clear, settled and informed wish to commit suicide;
  • The victim indicated unequivocally to the suspect that he or she wished to commit suicide;
  • The victim asked personally on his or her own initiative for the assistance of the suspect;
  • The victim had a terminal illness or a severe and incurable physical disability or a severe degenerative physical condition from which there was no possibility of recovery;
  • The suspect was wholly motivated by compassion;
  • The suspect was the spouse, partner or a close relative or a close personal friend of the victim, within the context of a long-term and supportive relationship;
  • The actions of the suspect, although sufficient to come within the definition of the offence, were of only minor assistance or influence, or the assistance which the suspect provided was as a consequence of their usual lawful employment.

It was interesting to read the different press reactions to the guidelines.

Washington Post: Britain To Clarify Policy on Euthanasia
Associated Press: Charges Unlikely for Helping Suicide in England
The Guardian: New assisted suicide guidelines to give ‘clear advice’ to relatives
Lesley Close (in The Guardian): Thank you, Keir Starmer
New York Times: Guidelines in England for Assisted Suicide
BBC News: Assisted suicide law ‘clarified’
Death with Dignity in Oregon
All of these articles point to one central point: these new guidelines are only a step towards changing the entire assisted dying/suicide law in England and Wales. This was only the first step.

The most interesting response to the decision from Timothy Egan at the New York Times. I highly recommend reading his piece The Way We Die Now.

Death + the Law Death Ethics Suicide

The Right to Die Free in Montana

Montana Court to Rule on Assisted Suicide Case
Kirk Johnson, New York Times (September 01, 2009)

Since July I have been posting stories on Right-to-Die cases in England. Those posts involved Edward and Joan Downes (who traveled together to the Dignitas Clinic in Switzerland to die) and Debbie Purdy who successfully fought a campaign to have England’s assisted suicide law changed.

Now it is America’s turn and in the great state of Montana no less. State motto: Oro y Plata…which means Gold and Silver in Spanish. I know.

I will let the Billings Gazette take the lead, with the August 29, 2009 article, State Appealing District Court Judge’s Ruling Favoring Assisted Suicide:

Robert Baxter, a 76-year-old former truck driver from Billings, spent his last months fighting for the right to hasten his own death.

Robert Baxter

Baxter was the Montana face and only named terminally ill patient in a legal case that sought to legalize physician-assisted suicide; he wanted doctors to prescribe him medication that would bring about his death and end his struggle with chronic leukemia.

Baxter died Dec. 5, 2008, the same day that Helena District Judge Dorothy McCarter ruled that the Montana Constitution protected the right of terminal patients like him to obtain lethal prescriptions from physicians.

This is an interesting case to watch because it involves the Montana State Supreme Court ruling on whether or not assisted suicide is legal. The other two American states with assisted dying laws, Oregon and Washington, both passed those laws by popular vote.

As always, I will keep my eyes on this case.

Death + the Economy Death + the Law Death Ethics Suicide

America and End of Life Care: Death, Dying, and Mortality

At the End, Offering Not a Cure but Comfort
Anemona Hartocollis, New York Times (August 19, 2009)

I started and re-started this post on American Health Care reform several times. To watch America’s current Health Care debate (such as it is…) makes me all the happier that I now live in the UK and am covered by the National Health Service. I have no problems with the NHS and I am glad that it exists.

Do Not Resuscitate Tattoo

One part of the NHS that impresses me most is its National End of Life Care Programme. The EOLC Programme’s mission statement provides a succinct mandate:

OUR AIM: To improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice.

What I think is fundamentally important about this NHS program is that it acknowledges the obvious: people die. Indeed, the program was explicitly created to embrace death so that the dying process is made as comfortable as possible for UK residents.

Do No Resuscitate

Herein lies one of the key reasons that I think the American Health Care reform debate is failing: Serious discussions about death, dying, and mortality have been jettisoned. What America needs more than ever, right now, is a National Conversation about dying because until that occurs, health care reform will continue to ignore that one part of human biology that we all share: Death.

And yet, paradoxically, it would seem that this kind of conversation is going on all the time.

The New York Times article at the top offers a lengthy and important discussion on End of Life Care in American hospitals. And NYTimes Health columnist Jane Brody offered this recent piece: End-of-Life Issues Need to Be Addressed.

President Obama made it clear in May that he was interested in a National Conversation about End of Life Care in a lengthy New York Times Magazine interview about the economy.

It is a long(ish) interview, so if you click here you can skip to the bit on Obama’s Grandmother and how her death informed his own thinking about End of Life decisions.

Do Not Resuscitate Bracelet

The problem, of course, is that people rarely talk to their family members about death. To bring home this point, the August 7, 2005 New York Times Magazine featured this article: Will We Ever Arrive at the Good Death?

Here is the key quote from that article:

As J. Donald Schumacher, president of the National Hospice and Palliative Care Organization, said last April to the Senate Committee on Health, Education, Labor and Pensions, “Americans are more likely to talk to their children about safe sex and drugs than to their terminally ill parents about choices in care as they near life’s final stages.”

Let me be clear that I think that President Obama is delving into an extremely urgent topic but, ironically, he is not the first modern American president to discuss end of life decision making. Oh no. Not by a long shot.

Some of the first presidential statements on death involved Ronald Reagan. In the early 1980’s, President Reagan received a series of reports on death and dying from some totally forgotten (but important) bioethics commissions:

  • Defining Death: Medical, Legal and Ethical Issues in the Determination of Death (July 9, 1981)
  • Deciding to Forego Life-Sustaining Treatment: Ethical, Medical, and Legal Issues in Treatment Decisions (March 21, 1983)
  • So, in a way, President Obama is attempting to carry out a project begun by President Reagan and is actually acting very Reaganesque. But I digress…

    For me, the key reason President Obama has seen his health care debate derailed is that he dared to embrace death. Or, at least, to suggest that end of life care is something that needs to be discussed (on the local and national level) since individuals need to be clear in their own heads about how they want to die.

    And since President Obama is involving himself in this debate, it means that the head of the nation is suddenly speaking out about death and dying. As a result, Obama is acknowledging a much more profound dilemma for modern America: the nation-state (as in America) usually ignores death at all costs.

    At a certain point, the nation can do absolutely nothing about death and instead it focuses on mortality. Death is utterly ignored by the nation because it represents that one, final act that an individual can choose and that beyond a certain point-in-time no life will return. President Obama isn’t anywhere near making statements about who lives and who dies. But he is making it clear that death is inevitable. (I am unfairly paraphrasing Michel Foucault’s comments from his Society Must Be Defended lectures, p. 248).

    That alone, I think, is causing some of the biggest problems.

    Do Not Resuscitate Logo

    All of this is to say, that American health care reform begins and ends with death. And until those discussions occur, America will continue with its current system.

    If you’re interested in making sure that your own end of life requests are followed, then use this information offered by Jane Brody of the New York Times.

    To help people make sound health care decisions and get the care they would want for themselves or their family members as life draws to a close, the National Institute on Aging has produced a comprehensive 68-page booklet, “End-of-Life: Helping With Comfort and Care.” Individual free copies can be obtained through the institute’s Web site,, or by calling 800-222-2225.

Death + Crime Death + the Law Death Ethics Suicide

Important Right-to-Die Court Decision in the UK

Debbie Purdy wins ‘significant legal victory’ on assisted suicide
Afua Hirsch, The Guardian (July 30, 2009)

An important turn today for UK Assisted Dying supporters (which is about 62% of the public…). Debbie Purdy successfully argued that it would be a violation of human rights for her to not know whether her husband would be prosecuted for accompanying her to the Swiss clinic Dignitas, where she wishes to die if her multiple sclerosis worsens.

Debbie Purdy and Omar Puente

The Purdy case is important and it will presumably force a change in UK law. As it currently stands, the UK’s 1961 Suicide Act decriminalizes suicide if you kill yourself. But any person whom:

aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years.

What that aiding, abetting, counseling, and procuring entails is really ambiguous. It is all so unclear that UK Prosecutors have been declining to press charges against families that accompany, say, a loved one to die in the Dignitas Clinic.

For an extremely thorough history on the Assisted Dying debate in the UK, see the Guardian’s Assisted Suicide page.

I discussed much of this information a few weeks ago in a Death Reference Desk post about the recent deaths of Edward and Joan Downes.

Since the Downes’ deaths and that discussion, I came across the following article: ‘Romantic’ death may idealize suicide: critics. Maybe. But I’m not so convinced. If anything, what Edward and Joan Downes chose to do was die and to die together. It was an act of love, to be sure, but I’m not ready to call it romance.

They chose death over a biological life neither one of them wanted to live.

It is absolutely acceptable to choose death. And family members and/or friends who want to assist in that choice should be able to do so without fear of the law.

But LOOK OUT: Scotland might beat England to the punch. Scottish MPs are discussing a change to Scotland’s own assisted suicide laws.

And Scottish MP Margo MacDonald is leading a fierce charge.

Death + the Law Death Ethics Suicide

British Couple Choose Assisted Dying at Dignitas Clinic

With Help, Conductor and Wife Ended Lives
John F. Burns, New York Times (July 14, 2009)

For several years now, the UK press has reported on individuals and couples who travel to the Dignitas Clinic in Switzerland to end their lives. The most recent articles focus on Sir Edward Downes and his wife Joan. Joan Downes had terminal cancer and based upon statements by family members, Edward Downes (who did not suffer from any terminal disease) accompanied his wife in order to die with her. The Downes’ case, while tragic, is but one of many over the last year. Indeed, a similar situation occurred for another couple, Peter and Penelope Duff, in March 2009. The Duff’s were a well-to-do couple who lived in Bath, England (where I am faculty member in the Centre for Death and Society at the University of Bath). They were both suffering from terminal diseases and chose to end their lives at Dignitas.

What emerges from all of these cases is an often overlooked point and an issue that I think deserves more attention. The services offered at Dignitas are not free and each assisted death costs roughly $6,750 US dollars (approx. 4,100 British Pounds or 4,800 Euros). I mention the cost, which will most certainly strike many readers as crass, precisely because choosing to die in a less-than-violent manner is increasingly becoming an option only for the affluent. The debate in the UK over assisted suicide absolutely taps into the ongoing debates about social class and it is apparent that individuals with access to the necessary funds will make their way to Dignitas.

The Guardian maintains an extremely valuable news archive on Assisted Suicide and I would suggest that all Death Reference Desk readers spend some time looking through the articles.

Interestingly enough, as debates about changing the UK’s laws on assisted suicide go on and on, two American states are often used as models. Both Oregon and Washington State have Death with Dignity Act laws and the Oregon law is often cited (and used) as a leading example of a rigorously reviewed, fair law. The Oregon Death with Dignity Act has even withstood judicial review by the United States Supreme Court (Gonzales v. Oregon 2006)

The UK’s assisted dying debate will most certainly continue as will the numbers of people choosing to die at Dignitas. This is a topic that I will also bring to the Death Reference Desk on a regular basis.