Autonomy Versus Life: Suicide, Depression, Lifesaving Interventions, and Free Will

Autonomy, to me, is sacred. I value it more than I value other things, competing things.

The direct opposite of autonomy is something like coercion or slavery. But to the side of that exists infringements on autonomy we’ll call “care,” including suicide prevention and breathing machines.

An illustrative, if stark, example of autonomy violating care is the metal cage around the toilet in the in-patient mental health facility Ken White went to. As someone with “I own me.” tattooed on my arm, the thought of getting in the way of someone who wants to kill themselves badly enough to disassemble a toilet to do it pisses me the fuck off, to be honest. Then again, the in-patient doesn’t have the right to disassemble a toilet they don’t own.

The fly is my atomistic ointment is that full autonomy is impossible. We’re all fighting our own brains all the time, to one extent or another. The rider fights the elephant. My friend Jessica bravely fights to stop the state from prosecuting people who help their loved ones stop suffering. I couldn’t support her organization, Compassion and Choices, more. Yet even I can acknowledge that sometimes I’m out of my mind. At my lowest point, maybe I want someone to intervene until I can feel differently.

Full autonomy is impossible because there’s no central, unified you. Free will has very little empirical basis. Conscious thought is the loudest of the at least four corners of your brain all shouting at you at the same time.

The question of autonomy actually rests on this question: How much does the part of your brain you like have to be losing against the part of your brain you don’t before you’re willing to let someone else’s brain make decisions for you?

It’s a question evangelical Christianity tends to answer differently than, for example, atheism. It’s a little ironic that the belief system which includes a terrific afterlife would chain people to respirators while people whose best guess is that what awaits you after death is black void of nothing for an eternity advocate for getting their sooner.

When I was active in the evangelical church in high school and college I was part of what is sometimes called a “culture of life.” The culture of life holds that human life is sacred. God gifts life, and our job as Christians is to guard those lives. Because all human lives are precious to God, they are precious to us.

Sometimes the culture of life butts up against other competing cultural beliefs. For example, it conflicts with the conservative desire for law and order, resulting in the much-mocked support for the death penalty among people who consider themselves pro-life. It also conflicts with the sex-negative aspects of cultural conservatism. It’s been empirically demonstrated that giving out free birth control and teaching kids how to use it actually prevents abortions, while laws that close clinics mostly make it more dangerous. Yet conservatives continue to pass laws to shut down clinics while doing nothing to offer broader access to birth control or education because they can pretend these laws don’t result in women having later, more dangerous abortions, getting kicked out of their homes and beaten by their husbands. But they can’t pretend that birth control and sex education fail to properly shame and stigmatize sex they don’t approve of.

I’m a little pissed about evangelical Christianity’s sexual ethic, in case that wasn’t clear. Those rare examples of cognitive dissonance aside, my experience with evangelical Christianity showed Christians consistently demonstrating reverence for human life through significant, sacrificial care for living people.

For a recent example, we can look to Richmond, Virginia where my mom is laying in an ICU bed. My stepmom, one of my stepsisters, and my baby niece are planning to drive up from Hazel Green, Alabama to visit her. That’s 10 hours and six minutes of driving, with light traffic.

Like a lot of first wives and mothers of the kids, my mom was sometimes a pain in my stepmom’s ass. She isn’t malicious, but she was often overwhelmed. She needed a lot of help. He was always there, every time the toilet broke or when we needed a lawn mower. Dad spent way above and beyond the state-mandated child support. My stepmom never, to my knowledge, resented my dad doing for us, and for my mom.

In return, mom gave dad more visitation than she had to. Soon after he remarried, we were spending all weekend, every weekend with dad, my stepmom and our two stepsisters. We went to church with them, and nearly every Sunday after church we’d have lunch as a family. Mom was always invited, and very often joined us, after her church let out.

I brought my best friend home from college one weekend. The private Baptist college my dad and stepmom are still paying off. Neither of her kids went to college. She told me later than when she heard my mom was coming over after church, she got anxious, ready for a showdown. It amazed her to see my mom and stepmom chatting happily, catching up, as they’d done since I could remember.

Inextricably linked with the culture of life is the culture of care. I’ve never seen it in my liberal, secular, rational, urban life like I saw it in the Southern Baptist churches of my youth. Ken Crane from church provided a last-minute babysitter, Christmas presents, church camp — things a single mother has a hard time getting together, provided by believers in the name of Christ. Mrs. Bruder, hunched over at the waist from rheumatoid arthritis, and her husband drove a school bus to pick up kids whose parents couldn’t or wouldn’t take them to church. These kids were neglected, and a handful. But she was unfailingly kind.

Sure, I haven’t shamed anyone about their sex lives since I left active church membership. But I also haven’t shoveled the remnants of someone’s home, still shit-covered from the broken sewer line, years after Katrina. I haven’t made small talk with strangers with dementia in a nursing home. Nothing is stopping me. And there are plenty of people who embody the culture of care without Christ. But there’s nothing driving me either, anymore. I’m no longer part of a community where that kind thing is expected.

Here’s another bugger about autonomy: Humans are terrible at predicting how we will feel.

When the Terri Schiavo case hit the news, I so fully immersed in the culture of life I absolutely could not empathize with the other side or comprehend the argument that her feeding tube should be removed. They seemed like callous Nazis to me. They seemed to look at her like an animal who needed to be put down. She was a person, not an impediment to her husband’s next marriage. Not a cost on a spreadsheet. Her life was sacred.

Until very recently, I viewed my own life as sacred. I always thought I’d want every medical intervention, for as long as possible. And I told everyone this, since they’ll likely have to convey the information.

But seeing at my mother in the ICU has shaken my desire for that. I didn’t realize how rudimentary pain management still is. After massive physical trauma, you basically have two choices. One: You can feel terrible pain from recovering from the surgeries and massive stapled up cuts. Don’t forget the discomfort from the breathing tube stuck down your throat and forcing your mouth open, cutting into your lips and drying your mouth out, drainage tubes coming out of your side, needles stuck in your arms, and boots that squeeze your legs to prevent blood clots.

Or, you can feel numbed, hazy, disoriented, confused, and sleepy. The only problem is, you’re not really getting better when you’re feeling that way. You need to get stronger to get off the breathing tube. You need to be alert and awake and fighting. Not numb and sleepy. So you can be in terrible pain and discomfort and get better. Or you can feel hazed out and just kind of atrophy.

Between Terri Schiavo and now, it’s not so much that I changed my mind on life being sacred. It’s more that I decided that autonomy is more sacred. There are a lot of reasons for this. The biggest is that as I began to see how freedom to make self-directed choices create innovation and prosperity. Technological innovation makes more of something people desire out of the same or less of what people have. It’s how lives get longer, better. It creates free time to read, learn, play. Property rights and the risk of failure, freedom and autonomy, people making choices in a market economy, that’s how you get innovation.

It’s also how you get progress. Challenging authority and dogma and starting to base your ethics around something other than superstition helps defeat bigotry and fear.

So it’s not actually accurate to say I see autonomy as more sacred than life. I respect the sacredness of life by supporting autonomy, because I believe it improves the quality and duration of life for the most people.

So I tattooed “I own me.’ on my arm and starting supporting assisted suicide and opposing abortion laws. Ultimately, I want a world which more fiercely guards autonomy than intervenes to make sure every person who’s ever lived lives as long as possible.

It’s not so much that I changed my mind on Terri Schiavo or the culture of life or life-saving interventions. It’s that I’ve recognized that the tension isn’t between loving people and Nazis. It’s between care and autonomy. It’s an argument between respecting someone’s agency and picking up the slack when their body breaks down or the shitty part of their brain takes charge.

Ken White at Popehat writes about needing to “put myself in the hands of the people who care about me.” Because, “As the Bloggess says, depression lies. Depression tells me that it’s never going to change. Depression tells me that there’s no hope, that I’m going to feel this way forever. Depression tells me I’ve tried everything to get better and it doesn’t work. Depression tells me that I’m a failure as a husband, a father, a friend. Depression tells me that I suck at my job — that if clients are happy with my work it’s only because they are deluded.”

I’m not depressed, I’m anxious. The lies my brain tell me include that my mother would be better off dead, because recovering is going to be grueling and painful, and her life is horrible and lonely and stressful anyway. It says my boss is disappointed with me and lying to me about being a good worker so I don’t quit before they can find a better replacement. It says that everyone is laughing at, not with, me for my writing and social media posts. It says that despite being utterly obsessed with myself, I ironically have zero self-awareness. It says I’m actually much, much dumber than I think I am. That I make people really uncomfortable in social situations and people hang out with me only out of morbid curiosity and pity. That my breath is bad. That there’s something in my teeth or on my face or my hair looks horrible. That I’m going to get fatter. That my IBS is going to get worse and my body will fail me but I won’t be able to afford healthcare so I’m going to die early because I chose to write for a living instead of doing something profitable. That I’ll never have another enthralling romantic relationship because I’m too emotionally healthy to get into another fucked-up relationship but too fucked-up to get into a healthy one. Also I’m wasting my beauty and youth. Also I’ll regret not going to grad school. Also I’ll regret not having kids.

This bitch in my brain makes life a little less enjoyable, denies me some sleep, tires me out, reduces the quality of my social interactions, etc. She works against the interests of the part of my brain that knows that my boss is being straight with me and some people genuinely enjoy my company.

I think of the first one as me and the second one as not me. There’s Cathy and there’s Bitch Cathy. Which makes me wonder. Would someone else forcing me to do what Cathy would want against what Bitch Cathy wants actually make me more autonomous?

We say depression lies and I personify my anxiety as Bitch Cathy, but of course it’s more complicated than that. Sometimes my anxiety is right. Sometimes I’m about to get fired. There’s evidence that for some people the threat of bad things happening is a more effective motivator than thinking about future rewards.

Bitch Cathy creates a lot of worst-case scenarios and loves to waste cognitive energy worrying about things that never happen so I have less brainpower to devote to the unanticipated problems that continually arise. But luckily for me, so far she hasn’t issued any directives other than “leave this relationship” or “leave this job.” She certainly doesn’t tell me to do anything I’d need someone to stop me from doing, like killing myself.

The question of autonomy comes down to when you’re willing to give control to someone else’s brain because yours has crapped out. Neither my brain nor my body has crapped out enough yet that I feel like I can know.

It was easy for me to be blithe about the preciousness of life until I’m staring down at my mom’s bruised, swollen face, bloody breathing tube, and unfocused gaze. And it’s easy to be blithe about my right to total autonomy until I contemplate Bitch Cathy getting louder and more demanding.

Autonomy, at the end of the day, requires a self that simply doesn’t exist. There are multiple selves, all competing against each other at all times. And constantly changing. At the same time, the society I want to live in requires a great deal of respect for agency. Care can’t justify people trampling on each other. It can’t force people to live miserable lives they desperately want to end. The empirical economic research strong supports that being free to make choices makes societies richer and healthier on average. Meanwhile, neuroscience strongly suggests that free will is merely an illusion.

The only thing I know about the tension between life and autonomy is that it exists, and they’re both important. I changed how I feel about autonomy and life. Would I want someone to keep me around until I changed my mind about killing myself? Would I want someone to force me to shit the bed while I scowled in pain, unable to speak?

I only know enough to know that I don’t know.

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