Suicide Affirmation and the Positive Right to Die

Undoing Suicidism: A Trans, Queer, Crip Approach to Rethinking (Assisted) Suicide By Baril, Alexandre (University Press, 2023). Around the time I began reading this book, a queer friend undertook a suicide attempt. Having awoken early, I was scrolling haphazardly through social media on my phone when I encountered a series of increasingly distressed messages posted by my friend overnight. These culminated in a post that clearly indicated her intention to die by suicide. My friend, who I met long ago while living in a different city, clearly felt desperately in pain and alone. It appeared that I was powerless to support her: I now lived far away, and intimately recognized the pain she reported as an individual subject to intense discrimination and social pressure. I did not think it would be helpful to call the emergency services. Stigmatized individuals such as queer and disabled people are frequently subject to further violence or abuse by the very service providers who are tasked with helping them at the scene of an attempted suicide (Krebs 2020). Indeed, another of my friends was once viciously brutalized by police officers called to the scene of her suicide attempt, so I had no desire to put this person at similar risk. I tried to find mutual friends to go round and check on her, but it was very early in the morning and no-one could make it for several hours. So I rang my friend. I sat, feeling completely helpless, on the other end of the line as she tried to kill herself. In doing so, I realized that I did in fact have something to offer. Regardless of whether or not my friend completed her suicide, I could ensure that, in this moment, she wasn't alone. In Undoing Suicidism: A Trans, Queer, Crip Approach to Rethinking (Assisted) Suicide, Alexandre Baril is deeply interested in the question of accompaniment, especially in terms of ensuring that suicidal people do not have to die alone. Informed by abolitionist politics which question the power that states and institutions hold over the conditions of life and death, Baril advances a meticulous critique of both existing suicide prevention measures, and the growing number of “assisted dying” laws which are being introduced in many jurisdictions. His arguments draw from an immensely detailed review of empirical evidence, philosophical accounts of suicide and death, and theoretical insights from queer, trans, and crip academics plus community workers. One of Baril's central arguments is for a suicide affirmative approach, entailing a “positive right to die for all suicidal people” (p. 9) and an ethical “duty to support suicidal people and their needs, including through assisted suicide” (p. 214). The idea is that people in emotional and/or physical pain should neither be subject to coercive suicide prevention methods, nor left to die, but instead provided active support and accompaniment. Baril acknowledges that many people's lives are already treated as less meaningful, important, or desirable in Western cultural contexts, including his home country of Canada: this can include older people and people with chronic or terminal illnesses, as well as queer, trans, and disabled individuals, plus Black, Indigenous, and people of color. He is therefore highly critical of existing assisted suicide or euthanasia laws in neoliberal contexts, arguing that they prioritize death over palliative or lifelong care, risk prioritizing the needs and desires of family members over those of the person who might die, and ultimately position certain kinds of lives as less worthy of living. His framework therefore strongly endorses efforts to tackle social injustice in ways that make everyone's lives more livable. Nevertheless, he also insists that no suicidal individual should be “hostage in our movement toward social revolution” (p. 169), given that some suicidal individuals will continue to experience forms of suffering that social justice solutions cannot address sufficiently or quickly enough. Another key contribution of the book is the concept of suicidism, which will be of particular interest to symbolic interactionists. Baril describes suicidism as a form of systemic discrimination targeting suicidal people, that manifests in the silencing of their voices, denigration of their experiences, and various forms of violence committed in the name of suicide prevention. Within this framework, the experiences of suicidal individuals who face violence from emergency responders or within psychiatric systems cannot simply be understood in terms of already-recognized forms of oppression, such as sexism, racism, ableism, or transphobia, but instead typically represent the intersection of these with suicidism. Suicidism means that suicidal people are often afraid or to talk honestly about their suicidal feelings, or are prevented from doing so. It also means that suicidal people are more likely to die, or attempt to do so, alone. If the only kind of support available is suicide prevention (potentially accompanied by violence), and third parties are likely to face punishment for supporting a suicide, then a suicidal person will typically feel unable to talk openly about their intentions, let alone seek accompaniment or active support for a more peaceful and less traumatic death. Baril posits that addressing suicidism through a suicide affirmative approach may actually prevent deaths. If people feel empowered to talk openly about their suicidal feelings, to explore options, and to seek help from healthcare providers and emergency services without risking incarceration or violence, then they will be less likely to hide their experiences and attempt suicide in secret. However, it is important to note that Baril also wishes to center suicidal people's desires and decision-making first and foremost, and therefore positions preventing suicide as a potential side effect of his approach, rather than his primary motivation. The arguments in Undoing Suicidism are extremely detailed, highly nuanced, and potentially very uncomfortable. As a researcher in trans healthcare, a feminist activist who has campaigned against unnecessary death, and a queer, trans, disabled person with numerous suicidal friends in my life, I found Baril's arguments to be profoundly challenging, and they forced me to reflect on many of my preconceptions. The suicide affirmative approach contradicts the intersecting ethical logics of neoliberalism, state-sponsored euthanasia, and what Baril refers to as the “suicide preventionist script,” which together treat certain groups of people as disposable while insisting that others should be prevented from taking their own lives at all costs. The structure of the book is therefore designed to carefully construct and justify Baril's arguments step-by-step. Chapter 1 reviews literatures of suicidality and introducing the concept of suicidism; Chapters 2 and 3 focus on LGBTQ and disabled/Mad perspectives; Chapter 4 critiques mainstream legislative approaches and social movements promoting assisted suicide for people with terminal or chronic health conditions, and finally Chapter 5 outlines Baril's own suicide-affirmative approach in detail, while responding to potential criticisms. The book's critiques of existing approaches are extremely powerful and well-informed. I nevertheless struggled with the lack of clear answers to many of the questions Baril raises, especially around how we might best support suicidal people in practice. It is very late in the book, toward the end of Chapter 5, that Baril very tentatively outlines a proposed “informed consent” approach to enacting suicide affirmation. This requires that a suicidal person be competent, consistent in their desire for suicide over several months, and accompanied in exploring their feelings over time before any assisted suicide takes place. A part of me found this account deeply reassuring, given that it offers a framework for ensuring people might be accompanied in suicide without rushing into death at a time of crisis. Simultaneously, I was concerned by how, while this approach is named for informed consent approaches to trans healthcare, it seems to instead emphasize forms of gatekeeping, echoing language around the assessment of “persistent” and “insistent” desire as a condition of care for trans people (Newhook et al. 2018). But of course, as Baril himself acknowledges, Undoing Suicidism is intended to move conversations around suicidality on, rather than act as an end point for discussion. As I finished reading the book, my thoughts returned to the friend who I found myself accompanying, on the phone, during a suicide attempt. Baril suggests that the preventionist script is so deeply embedded in contemporary, Western approaches to suicide that it can be very hard for readers and interlocutors to embrace a suicide affirmative approach. This is the case even for those who accept the existence of suicidism. Yet the point I found myself returning to was: no suicidal person should feel they have to die alone. The greatest strength of Undoing Suicidism is that it unflinchingly seeks to address that fundamental injustice. Ruth Pearce is Lecturer in Community Development at the University of Glasgow. Her work explores issues of inequality, marginalization, power, and transformative political struggle from a trans feminist perspective. Ruth is co-editor of the Community Development Journal. She is the author of Understanding Trans Health (Policy Press, 2018), plus co-editor of The Emergence of Trans (Routledge, 2019) and TERF Wars (Sage, 2020).

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