Preventing suicides by assisting them

Alexandre Baril’s research sits at the crossroads of gender, queer, trans, disability/crip/Mad studies, critical gerontology and critical suicidology. In a new book, the Associate Professor from the Faculty of Social Science’s School of Social Work has a radical approach to helping suicidal people, asserting that existing suicide prevention services do more harm than good.

We sat with him so he could tell us more about Undoing Suicidism: A trans, queer, crip approach to rethinking (assisted) suicide.

Question: In your book you argue the suicidal are oppressed by structural suicidism, a hidden oppression
Alexandre Baril: “I coined the term suicidism to refer to an oppressive system in which suicidal people experience multiple forms of injustice and violence. Our society is replete with horrific stories of suicidal individuals facing inhumane treatment after expressing their suicidal ideations. The intention is to save their lives at all costs and interventions range from being hospitalized and drugged against their will, to being handcuffed and shot by police, to losing their jobs, to having their parental rights revoked, to even being kicked off university campuses. Thus, suicidal people often remain silent and complete their suicide without reaching out to anyone.”

“Worse, I argue that suicide prevention services do more harm than good. Simply put, suicide prevention often increases deaths by suicide rather than prevents them. This is especially true for marginalized suicidal people such as Indigenous, racialized, homeless, poor, queer, trans, disabled, neurodiverse and Mad individualsexternal link, for whom suicide intervention often increases the racist, colonialist, classist, sexist, heterosexist (or homophobic), cisgenderist (or transphobic), ableist and sanist violence they experience. My thesis is that suicidal people are oppressed by suicidism and the oppression they experience remains under-theorized.”

Q: Support for suicidal persons is not working. Please explain why that is.
AB: “Suicide statistics remain relatively stable and have not improved significantly over the past decades. Despite decades of multiple strategies and billions of dollars invested in outreach initiatives, studies show that those most determined to die carry out their suicidal plans without reaching out for help. In sum, our prevention strategies do not work.”

“My work found current prevention services generally fail to connect with suicidal people, who do not feel safe asking for help. This silencing effect, due to suicidist consequences (experiencing forms of harm when revealing suicidal plans) leads suicidal people to not feel supported to share their distress.”

Q: You believe that offering assistance in dying to suicidal patients would better prevent unnecessary deaths. How?
AB: “The most radical idea of my book is to theorize suicide as a positive right that would involve supporting suicidal people in their quest for death through assisted suicide. This support would be delivered through a suicide-affirmative approach. This might save more lives than current prevention strategies.”

“This non-stigmatizing approach would provide suicidal people with the chance to speak freely and to benefit from an accompaniment process to reach an informed decision about their desire to live or die. My approach has the potential to drastically reduce rates of suicidality, particularly among marginalized groups, by opening channels of communication with people who are currently too afraid to reach out for help.”

“Even for the small minority of people who would go ahead with an assisted suicide, they would have a less lonely and violent death and a relational process of dying that would also be less traumatic for family and friends.”

Q: Should this idea ever come to fruition, what kind of impact would you expect to see? How would this influence a person’s suicidal ideation?
AB: “My approach is a radical de-stigmatization of suicidality. Slogans such as ‘Speak Up, Reach Out’ or ‘Let’s Talk’ urge suicidal people to share their distress. But suicide prevention services send a paradoxical message since those who open their hearts often experience harm, forced treatments, and rights violation in the name of care and of saving vulnerable people from themselves, all because suicide is never an option.”

“Through my approach, suicide becomes an option, one that should be carefully thought through within an accompanied process during which various options would be seriously considered to help the person make an informed decision. By removing the suicidist violence suicidal people experience when they share their suicidal ideations and plans, and by supporting the assisted suicide of the person if they determine that this is indeed the best option for them, suicidal people would finally feel safe to speak up, reach out for help and talk about their distress. In my approach, the priority is the suicidal person, not life itself. Instead of completing their suicide without speaking with anyone, they would be accompanied as they contemplate making this crucial decision, weighing all the pros and cons, informing their relatives and family members, and preparing for this passage from life to death.”

Q: Are there examples of this model working elsewhere in the world?
AB: “There has never been a model such as this before. Throughout history, some philosophers, bioethicists and thinkers have promoted the right to die by suicide, but it’s always a negative right. Those in favor of a positive right to die limit this exclusively to the context of assisted death in the case of disability/sickness/illness.”

“My work questions why we offer assistance in dying to people who, in the vast majority of cases, don’t want to die and ask for better living conditions. And those who do want to die, such as suicidal people, are denied any assistance and are forced to die alone in atrocious conditions. If such an idea was adopted, it would lead to a completely different social, political, and legal landscape than the one we are used to. This is an out-of-the-box idea, which invites us to radically rethink both our perspectives on suicide and assisted suicide.”

Q: The inspiration comes from the support that transgender persons receive. Please elaborate on this parallel.
AB: “The positive right to assisted suicide for suicidal people may be new, but my suicide-affirmative approach is inspired by trans-affirmative approaches to rethink the care offered to trans people – not based on forms of control and gatekeeping – but to support their autonomy. My suicide-affirmative approach is anchored in self-determination, informed consent, and harm reduction. Instead of trying to cure trans people of their transness or suicidal people of their suicidality, we develop safer spaces in which we can examine their suicidality with them and discuss a variety of options.“

“A shift from prevention to accompaniment would empower suicidal people. Similarly to a trans-affirmative approach, the suicide-affirmative approach offers care 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.”

“Regarding the theorization of suicidism and the rights and recognition of suicidal people, we are currently where trans people were regarding trans rights and recognition in the 1930s. Indeed, everything needs to be imagined, theorized, and transformed, as was the case for trans people several decades ago when transitioning was not even an option. My work constitutes a first step in this direction; it allows us to open our hearts and imaginations regarding the possibility of envisioning suicide and assisted suicide from a different point of view, from the standpoint of suicidal people.”

Baril, Alexandre. (2023). Undoing Suicidism: A trans, queer, crip approach to rethinking (assisted) suicideexternal link, Foreword by Robert McRuer, Philadelphia, Temple University Press, 334 pages.

Online book launch: Friday, May 26, 2023, 12:00 to 1:00 pm EDT (Eastern Daylight Time). Register on Zoomexternal link.

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