The Suicide State: Do they want us dead or alive?

On assisted suicide, eugenics healthcare, and the criminalization of depression and illness.

Ashley Reese, who fights with disabled people often online, uses an unfortunate comparison in talking about dying people.

A few weeks ago, there was a heated debate online on the topic of assisted suicide. The conversation started with sick and disabled sounding alarms on Twitter about the expansion of assisted suicide programs to non-terminal cases in other countries, including Canada, the Netherlands, and a proposed bill in the U.K. As human rights organizations have outlined, people are being pressured into state-supported suicide by family members or in place of medical care or social support, even in U.S. states like Oregon, where cases are supposed to be terminal.

“Death with dignity” supporters, many on the left, weren’t willing to listen to these concerns. They invoked “bodily autonomy” without recognizing the well-documented role of coercion. In an ideal and less ableist world, there would be safe options for people to control their fates, but this isn’t that world. Ableism is baked into the platform of the “death with dignity” movement, as disability often entails life without “dignity,” filled with suffering and need for assistance. So the assumption that an undignified existence would be reason enough to die is offensive, but that’s at the root of so much eugenics.

Disabled people know the history of Hitler’s Aktion T4 and the medical establishment’s support of it in the name of easing the suffering of disabled people through death. We see Hitler’s rhetoric echoed in the promotion of expanded assisted suicide, with reference to disabled people as burdens and “useless eaters.”

I don’t want to rehash every corner of the assisted suicide debate. Instead, I want to talk about how it connects to broader social issues, including the eugenics state and the criminalization of suicidality.

Ironically, just as the assisted suicide debate faded, another conversation took over online, in the wake of the assassination of the C.E.O. of United Healthcare. People shared stories of healthcare denials, of the medical system pushing people into death and bankruptcy. For some of us, there was a through-line between these two conversations. As scholars have explained, the modern euthanasia movement emerged out of the eugenics movement of the 20th century.

While the state is killing the vulnerable among us, quickly or slowly, you can also be punished for attempting to take your own life. Indeed, there is a comprehensive police apparatus that controls, punishes, and institutionalizes attempted suicide, serious depression, and other mental illness.

It’s an apparent contradiction, one that only makes sense in the context of the criminalization of disability—a context in which, if you lack ability or suffer, you can’t win.

Hospice

Last year, my father’s health suddenly plummeted. His energy started slowly falling. After taking an ill-advised long walk, he couldn’t walk. Then he couldn’t get himself out of bed or stand up when he fell. He also stopped eating. It was a curious mess of issues, culminating in his heart rate falling below 30 and two hospitalizations over six months.

There was some confusion about what was wrong with him. A doctor diagnosed him with cancer, then the hospital admitted it had mixed him up with another patient, who had cancer. Another cancer was suggested as a possibility, but my father wasn’t interested in invasive testing.

He left his second hospital stay in not-great shape and was put in home-based hospice. It was the only way he could get sustained medical attention. Three times per week, hospice nurses visited and took vitals, dropped off supplies, and provided a large supply of pain medication.

In exchange for this support, my father had to follow the central rule of hospice in the U.S.: he had to forgo any life-saving measures. Hospice is known as end-of-life care, but the rules of hospice make sure of it.

I didn’t like the rules of hospice. I’m disabled and have become intensely sensitive to eugenics, especially in the last few years. I’ve published about eugenics under Covid. To me, the rules of hospice in the U.S. seemed like a poisoned carrot dangled in front of someone sick and in desperate need. There’s no good reason that very sick people couldn’t be provided the support they need and have life-saving procedures.

My father wasn’t in too much pain, so he didn’t use the drugs, but I could imagine how someone suffering from chronic serious pain would find the medication supply irresistible. The government’s senseless crackdown on pain medication prescriptions has made it impossible for people to access what they need. Hospice gives people like my dad liberal pain medications in exchange for agreeing to die soon.

My dad didn’t mind the hospice rules. He was suffering, over 80, and at peace with dying. Seven years before, my mother had been in a home hospice program, but she kept breaking the rules. She was far sicker than my dad ever got, with a known cause, but she had a will to live.

Hospice came up in the conversation on assisted suicide, as people argued that some large percentage of the people who chose suicide were in hospice or had cancer. Their point was that these people were “going to die anyway.”

What was missing from that discussion was how hospice in the U.S. is already assisted suicide. It may do wonderful things for many people, but it is also an insurance plan designed to save insurers money by passively killing off very sick people, using enhanced support and medication as bait.

Supporters of assisted suicide framed hospice as necessarily end-of-life care, and the program tries to be, but people recover and leave hospice not infrequently. My father had a spontaneous recovery and is no longer in hospice. It turned out he had a confluence of specific issues that needed to be addressed, not a global deadly issue.

I’ve heard from doctors and hospice nurses that people often leave hospice because they experience relief and support for the first time in a while, including pain management. They no longer accept death as inevitable or desirable.

The rules of hospice in the U.S. are one example of how the state incentivizes “assisted death” for people it deems non-desirable beyond lethal injections. The dropping of Covid protections is another. The increased cost of healthcare and expansion of insurance denials is another—together with the system that makes fighting back too exhausting and costly for the unwell. The unaffordability of housing and criminalization of homeless people—shuttling them into more and more dangerous and deadly circumstances by removing benches, stealing their tents, and so on—is another way the state incentives the vulnerable to give up. These and other mechanisms (including the prison system and other institutions) also increase disability, driving people into a cycle of ever descending eugenics—like the world flushing vulnerable people down the toilet.

Disabled people warn about the expansion of assisted suicide, because we are aware of how the state is already, and increasingly, encouraging us to give up, usually framing it as a choice. But most of us are not actually allowed that choice.

Criminalizing Depression

In 2016, I hit bottom. I was into my fifth year of near-daily migraine headaches triggered largely by environmental exposures. I had been forced to give up a very full life of working, performing, and socializing. I was moving constantly for years, either to get away from severe migraine triggers or because the housing I did find was temporary and unaffordable long-term. I also had just been through a medically-necessary double mastectomy and expander-to-implant surgery which my body couldn’t handle.

Eventually, my husband had enough of all of it, so he dropped me off in a hotel, with no ability to work or provide for myself, only the small amount I got from social security disability insurance until we arranged temporary alimony. I moved into my parents’ house, where my mother smoked a pack of cigarettes per day. The smoke, embedded in the walls and ducts, made my health much worse.

All of this would be enough to drive someone to suicide, but it was just the aggravating circumstances. The deeper cause was a drug called Topamax, an anti-seizure drug intended to treat my migraines. It caused serious cognitive and mental health symptoms, progressively, over two years. Eventually, I couldn’t eat, communicate, or write normally, and I started experiencing psychosis and paranoia. My doctors suggested it was just migraine-induced depression, even though Topamax comes with mental health warnings. I was afraid to go off of it. I was afraid things would get worse.

When my husband left, I had much less to lose. I decided to go cold turkey off of Topamax, never a good idea with mind-altering medications. I started spending all my time planning my suicide. I researched deadly injections on the dark web; I bought a gun; I stole my mother’s pain pills. I was gathering the courage to end things, though this went on for a couple of months. So I clearly, also, wanted to live. Some high school friends reached out and, when I told one of them I wanted to die, she called the police on me. The police showed up and, despite my calm positive demeanor and my parents’ assurance that they would look after me, I was handcuffed and involuntarily detained. I was punished for being depressed.

In the hospital, I was surrounded by people who had no reason to be there. One man had been on the phone with his health insurance company. When they kept refusing to acknowledge his needs, he said, “Oh my god, I’m going to kill myself!” The police were called.

I may have needed more help than him, but this wasn’t the place. The hospital was prison-like. My dietary needs were dismissed and mocked. A nurse was abusive with me when I had migraines and seizures and couldn’t control them. He came to my bed in the middle of the night and whispered that he knew I was lying. Then he violently threw me into a locked solitary confinement room which was freezing, with no blanket. The psychiatrist on staff tried to put me on medications that had previously given me adverse reactions, and he refused to call my old doctors to confirm what I said. Eventually, I threatened to call a lawyer on the nurse and got sent home early. This wasn’t the only time that law enforcement and its extended powers have mishandled me during migraine/seizure episodes.

If your friend is threatening suicide, don’t call the police. All of the evidence shows that when suicidal people are involuntarily committed, they get worse.

Involuntary holds are a part of “The Prison of Help,” as I wrote about previously, together with “Care Courts,” diversionary courts, and conservatorships. They are extensions of the long arm of the criminal justice system, and they are rapidly being expanded in the U.S. They are promoted as humane, help-oriented responses to people in crisis, but they don’t give people choices. They take away power and freedom.

The government, theoretically, doesn’t want you to kill yourself. I was punished for having that will. Suicide hotlines work closely with police, with about 25% of calls being directed to police without the caller’s knowledge. This, despite evidence that people become more suicidal during involuntary holds. There’s no deterrence effect. It’s much like the prison system. They aren’t locking people up to prevent crime. People are more likely to become more hardened and desperate criminals once released. Similarly, they aren’t locking up suicidal people to prevent suicide.

So what do the state and its supportive systems want? Do they want to kill people who are sick, poor, disabled, and elderly? Or do they want to stop people from killing themselves?

At root, the state seeks to control and criminalize disability, whether that means withholding care from people in hospice, pushing suicide on people who struggle, making the conditions of life as a vulnerable person impossible, and/or locking up people who are in severe depression and seek to control their own fates.

There’s a profit motive behind a lot of this; corporate wealth is the tie that binds. For disabled and vulnerable people, as noted, we can’t win.