Hel Spandler reviews a powerful new book in the context of debates about assisted dying in the UK

Undoing Suicidism: A Trans, Queer, Crip Approach to Rethinking (Assisted Suicide)

As assisted dying becomes hotly debated again, it raises critical issues in mental health care. In a few countries (such as the Netherlands, Belgium, Luxembourg, and Switzerland) assisted dying legislation includes people with ‘severe and persistent mental illness’, and whilst this is not (yet) on the cards in the UK, many survivors and activists have expressed understandable concerns about this. It is especially concerning in the context of attacks on welfare recipients and threadbare services where only short-term support and ‘recovery’ seems to be an option. There are real concerns that there will be more support to end people’s lives than to create the conditions in which people lives are worth living.

At the same time, there are powerful arguments for the right to have autonomy over our own bodies and decisions over our own lives and deaths. A ground-breaking new book has recently been published by a suicidal activist/scholar, Alexandre Baril. Undoing Suicidism is one of the most challenging and unsettling books I’ve read in a long time. It’s meticulously researched, theorised and extremely compelling, but deeply troubling in equal measure.

The author has lived with suicidal feelings most of his life and has clearly reflected on these issues deeply. He argues that suicidal people face what he refers to as structural suicidism – that is, they face oppression and discrimination, purely on the basis of their suicidality, for example by being treated and detained against their will. He also suggests that well-intentioned suicide prevention strategies frequently fail suicidal people. For example, it forces suicidal people to hide their intentions to die and, as a result, they can end up taking their own lives, desperately alone and unsupported. Moreover, he suggests that suicidal people face oppression from all quarters, including from people ostensibly ‘on their side’ who refuse to accept their suicidality. Indeed, he suggests that whole systems have been established to convince suicidal people that they are pathological, that they don’t really want to die, and it’s a just phase that will change with treatment and intervention.

I find it hard to disagree with any of this. However, it gets tricky when the author endorses what he calls a ‘suicide affirmative’ approach. This means that he not only supports suicidal people’s right to take their own lives, but also their right to have the support they need in order to do so. This doesn’t mean he’s suggesting that suicidal people should take their own lives, but that they should be fully supported to make whatever decisions they feel is best for them, and this should include the possibility of suicide.

This seems to go against our better instincts, that we should preserve human life and support people to live. However, this is precisely the author’s point. Suicidal people are so isolated and marginalised, their desires so unacceptable and wrong, and therefore, they must be stopped – at all costs. This is what he means by ‘suicidism’. And most of us are guilty of it. Asylum certainly is. We never question the assumption that suicide represent a failure, albeit usually of services or wider society, but a failure nonetheless. Whilst Baril is no less critical of mental health services, in his view we’d need to question this assumption. Why, he asks, should we assume that life is worth living and impose, often violently, that assumption on everyone?

This is such a difficult and sensitive issue and Baril’s arguments are so complex and nuanced that it is almost impossible to do them justice here. Unfortunately, however, complex ideas rarely translate well into policy and practice and, despite his compelling argument, I have serious concerns about how it could be applied, especially in our current socio-political context.

We frequently see even mildly progressive legislation and ideas used in very reactionary and damaging ways. One current example in the UK is how the Mental Capacity Act is used as a justification for refusing to provide support to suicidal people on the grounds that they ‘have capacity to decide to kill themselves’ so services don’t need to intervene, despite the person wanting them to. It’s not hard to imagine a situation whereby people who are feeling suicidal, are assessed as not really suicidal unless they are willing to access support to die. Whilst this isn’t what Baril is proposing, any whiff of a ‘suicide affirmative’ approach could be used in similar ways i.e. to withdraw support from people who are actively suicidal.

In addition, one of the main ways that we currently measure & critique mental health systems and society is by highlighting increasing levels of suicides, especially amongst oppressed groups. This gives us leverage in demanding public inquires, investigations and reviews, as well as justifying the need for wider social change. If we no longer assume that suicide is necessarily a negative outcome, we could lose a way of holding services – and society – accountable. We know – from the testimonies of people who have taken their own lives, and their families and friends – that suicide is often linked to extremely poor mental health care (as well as other social factors such as ablism, transphobia, homophobia, poverty, racism etc). Baril is painfully aware of this too, but how can they ever be separated?

If assisted dying is legislated for people who are terminally ill, excluding people with mental health conditions or psycho-social disabilities might seem sensible. However, Baril suggests that excluding mad people from assisted dying, isn’t protecting them, but is actually a form of sanism because it assumes that suicidal people are irrational, wrong and in need of saving from themselves. Can we have it both ways? Can we accept mad people’s judgments and perspectives, but only if they agree not to do things we don’t like? Is it ok to oppose compulsory treatment and detention, but make an exception for people who are suicidal?

These questions go to the heart of key dilemmas in mental health politics. Whilst there are no easy answers to this conundrum, I think two things are clear. First, whether or not we support people’s right to die, the current political situation is an extremely bad context in which to introduce this kind of approach. Second, we desperately need to hear the voices of those who remain suicidal, or who have died by suicide, and not merely interpret them through our own assumptions and positions. Neither of these undermine Baril’s argument per se, but it leads me to be very cautious about endorsing it.

This is a Sample Article from the Summer 2024 issue of Asylum [31.2].   To rear more, Subscribe to Asylum Magazine