One of the most difficult aspects of Szasz's philosophy, for me, has
been the idea that people have a right to end their own life if they
choose to. However, while it took me a while to come around to this,
I now agree with Szasz completely that not recognizing the right to
die has been the source of many problems. If we are really to respect
individual liberty, we must respect this one as well.

I would like to think that under a freer society people would be
happier and commit less suicide.

Here's an interesting opinion piece from a Japanese newspaper that
appeared just yesterday. I've inserted comments.

Here's the link first:

http://www.asahi.com/english/Herald-asahi/TKY200705120065.html


> Mai Uchida: Doctors have a duty to help prevent suicide
>
> 05/12/2007
>
> THE ASAHI SHIMBUN
>
> This year's national medical licensing examination held in February
> had more questions on suicide than usual.
In other words to get your license as a doctor you need to know about
suicide as it is a disease.
> Many students no doubt found them difficult because the questions
> were quite different from past ones. I found the contents of the
> questions very thought-provoking.
> In Japan, more than 30,000 people take their lives every year.
> Japan's suicide rate is the highest among industrialized countries.
Despite the presence of capitalism in Japan, there are many
socialized institutions. Even large businesses have strong
connections with the governments. Until Japan's long economic slump
Japan was considered a potential third way between socialism and
capitalism.
> How many students who took the exam were able to choose the right
> answer with confidence from a multiple-choice problem that asked
> about this fact? I picked the right answer by eliminating other
> ones that I thought were wrong. But I was surprised at the
> seriousness of the situation.
It's very serious when someone commits suicide. It is even more
serious when many people commit suicide.
> One of the figures in the exams showed that the number of suicides
> started to grow steeply in the late 1990s. I heard that the
> increase of suicides of middle-aged and older men correlated with
> the slumping economy but never thought the situation was so
> serious. I felt ashamed of myself for my inattentiveness as a
> medical student.
So the bad economy is responsible for the suicides?
> It is believed that many suicide victims were suffering from
> depression but had not sought medical treatment. Since many cases
> of depression can be cured, Japan has apparently been producing
> many deaths that could have been prevented, had they been treated
> properly.
This says: Suicide is a disease. It is up to ordinary doctors to cure
it.
> Moreover, hundreds of thousands of bereaved families are grieving
> over the loss of their loved ones.
This is inevitably true.
> In Japan, the number of suicide victims is about four times that of
> people who die from traffic accidents. We say anyone can get killed
> in traffic accidents, therefore, let's be careful and prevent them.
> But it is questionable how many people in our society have the same
> awareness about suicide.
But we don't say people who get in traffic accidents were sick or
diseased. We say that rules of the road can be improved, or that the
driver should have been more attentive.
> In 2005, researchers from 15 countries reported that two measures
> proved useful in preventing suicide. One is restricting access to
> lethal means such as guns with which people can kill themselves in
> a split second with the pull of a trigger.
Japan has fairly severe control of hand guns. Yet it has one of the
highest rates of suicide. But not one ever tries to connect the dots
this way. Not that they should necessarily, but there's a clear bias.
> The other one is depression education that targets primary care
> physicians who are usually the first medical personnel to see
> patients suffering from depression.
This says: Doctor's must be anointed to look after our ethical well-
being.
> According to the report, primary care physicians who noticed signs
> of depression and suicidal thoughts in their patients were able to
> lead them to receiving appropriate diagnosis and treatment. As a
> result, it contributed to the prevention of suicides.
Where? When? How do we know this?
> One of the questions in the national exam cited a case of a patient
> whose chief complaints were severe dizziness and nausea accompanied
> by insomnia and lassitude. He also suffered from job-related stress
> that made him reluctant to go to work.
Perhaps for some life time employment isn't as good as its made out
to be. A more flexible system where it's easier to change jobs might
be better for some. Why are we saying the man is sick. Maybe his
response was a reasonable reaction to the work he was doing?
> The question asked what conditions must doctors pay most attention
> to. The answer was "suicidal thoughts."
Doctors must know what you are thinking now. If your thoughts are
troubling, they will decide you are diseased, and this will go on
your medical record.
> I wonder if every doctor would have the courage to ask such a
> depressive patient, "Do you feel that you want to kill yourself?"
Perhaps at the behest of the government they will soon find it a
positive responsibility.
> Some doctors may not take the complaint seriously and tell the
> patient, who might be suffering from depression, "you won't die
> from stress."
That's the case now, probably.
> They may send the patient home saying "try to do your best." But it
> is taboo to encourage patients with depression too much. What if
> the patient went home and committed suicide? How would the doctors
> feel? I don't ever want to feel that way.
I've never had anyone close to me commit suicide. That would be
trying. Even just knowing someone that I'd met in an casual encounter
had shortly afterward commit suicide would bother me. I'd think, if
I'd known they'd been so depressed, maybe I could have given them a
word of hope. Certainly for at least a while this would haunt me. But
I think Szasz is right, that people need this freedom. Too much
trouble has been stirred up by making depression an illness and then
authorizing do-gooders to interfere.
> Society is urged to make an effort to eliminate stress caused by
> slumping economic conditions and poor work environments.
Less government control is probably what's needed. So this is an
ironic solution if it implies the government must do more.
> At the same time, we need to recognize the fact that Japan's
> suicide rate is exceptionally high and that suicide could affect
> people close to us. People who are feeling excessive stress may be
> developing depression. It is important that they can have access to
> special medical treatment.
> Having taken the national exam, I thought we must do everything we
> can to lower Japan's exceptionally high suicide rate.

This doctor is clearly a true patriot. But is he concerned about a
number, or individual liberty for the people in Japan?

Best,

Matt Dioguardi