Expressive Individuals

What It Means To Be Human: The Case for the Body in Public Bioethics, O. Carter Snead, Harvard University Press, 2020.

As we start a new year, mental health is on a lot of people’s minds. Half of Gen Z’ers plan to improve their mental health as a Near Year’s resolution, according to a Forbes Health survey of 1,000 U.S. adults released in December. Media are urging much the same, such as a post-Christmas New York Times article entitled “How to Improve Your Mental Health in 2023.”

The focus makes sense, given record levels of drug overdose deaths, a spike in mental health-related visits to emergency rooms among adolescents, and a rise in deaths by suicide.

But the public concern about that last one befuddles me. Yes, September is National Suicide Prevention Month, and all month the radio airwaves are filled with disc jockeys urging people not to take their own life. And this past July, the federal government announced a new three-digit 988 Suicide & Crisis Lifeline for people suffering from a mental health crisis and suicidal ideation. Yet, simultaneously, many of those same people wishing to save a life want to make it easier for Americans to kill themselves: Ten states and the District of Columbia already permit physician-assisted suicide. Other western nations including Canada, Belgium, and Switzerland, are way “ahead” of us.

What explains this contradiction? In What It Means To Be Human: The Case for the Body in Public Bioethics, Notre Dame law and politics professor O. Carter Snead offers the core of an answer: the role of what sociologist Robert Bellah called “expressive individualism.” That idea, deeply popular in contemporary America, posits that persons are merely atomized individual wills that flourish by self-expression based on whatever “truths” one identifies as central to the self. “In this paradigm,” writes Snead, “the goods of autonomy and self-determination enjoy pride of place among ethical and legal principles.”

According to the expressive individualistic worldview, the body serves as mere inchoate matter to be harnessed and repurposed to serve the feelings and desires of the autonomous will. “This conception of personhood decisively privileges cognition as the indispensable criterion for membership in this category of beings,” Snead explains. The body, consequently, is subordinated to the will, because it is not fundamentally part of the authentic self.

Our current legal framework is deeply influenced by this anthropology, which prioritizes the right of privacy, or what is sometimes called the “right to possession and control of one’s person,” or the “right to be left alone.” The goal is to ensure that individuals have the freedom to construct their own life narrative according to the will’s personal preferences. Indeed, as Snead explains, the two goods frequently cited in favor of assisted suicide are autonomy and compassion.

For example, an amicus brief filed to the Supreme Court by several famous American moral and political philosophers during the court’s consideration of Washington v. Glucksberg and Vacco v. Quill (and subsequently published in the New York Review of Books), emphasized the importance of self-definition. Death, the philosophers wrote, is “the final act of life’s drama, and we want that last act to reflect our own convictions, those we have tried to live by, not the convictions of others forced on us in our most vulnerable moment.” Or, put more bluntly, Americans require the freedom to choose self-annihilation as part of their life narrative.

The expressive individualistic paradigm explains our confused, bipolar approach to suicide. Since the body is not really part of us, when it breaks down, or no longer serves as an effective tool for self-actualization, then what is most important about us, our capacity for self-expression, is compromised. Severely disabled persons, people who have suffered traumatic injuries, or those with terminal illnesses often suffer incomprehensible pain. Perhaps they were once healthy and happy, but now they are a shell of themselves. Or, as expressive individualism might say, they have lost the ability to even be themselves. The only freedom that remains, we are told, is that of exercising the will to end a now miserable life.

But things are different for those still in reasonably good health but who are experiencing a period of depression or anxiety, or perhaps are going through a rough patch of financial insecurity. They can still enjoy a delicious meal, play a game on their smartphone, or watch an evening sitcom. They might even be able to go for a walk, play paddleball, or complete a 5K. “Surely someone able to complete a 5K shouldn’t be thinking about committing suicide!” we declare with deep sympathy for the distressed.

Such persons, we judge, shouldn’t be encouraged to kill themselves, but to get the professional help they need. “You can get through this!” we exhort them. There are many good things left to enjoy, we remind them, many avenues still available for pleasure and expressing their identity.

It is not exactly the surest ground on which to stand, as other countries’ laws on suicide suggest. What if someone, even in good health, decides they have exhausted all the good things we assess worth living for? What if their depression or anxiety are so terrible, so debilitating, that the person would rather be dead than live another day? Who are we to tell them “Not until you try Pad Thai, see this TikTok video, or try one more romantic fling!”

The problem here, as Snead observes, is that expressive individualism is a “reductive and incomplete vision of human identity and flourishing.” Not all our obligations are unchosen, nor all our relationships instrumental and transactional. We are vulnerable and dependent beings, and there are other vulnerable beings dependent upon us. Parenthood alone teaches us this truth, but so do many other social realities, given how much we are shaped by (and indebted to) inherited cultural traditions, institutions, and mores. As British philosopher Sir Roger Scruton observed: “We are bound by ties we never chose, and our world contains values and challenges that intrude from beyond the comfortable arena of our agreements.”

We are not, nor ever have been, the atomized selves that our current legal regime tells us we are. We are people in community, with obligations to others (including God) that we fail to honor by killing ourselves. Even the person suffering terminal illness or a severe handicap deprives others of the opportunity to lovingly serve them in an act of self-sacrifice. And the suicidal deprive themselves of the opportunity to be loved in their most vulnerable moments. You may think your life worthless, but others who need you may not agree. Assisted suicided laws, says Snead, are “not well-designed to address the complex needs and wants of a community of embodied, vulnerable, and interdependent human persons.”

The answer, then, is not to play this dangerous, even disastrous, game of threading needles of what manner of assisted suicides are ethical or not, as our northern neighbors are now doing. All suicide, in one form or another, vitiates our dignity as embodied human persons able to give and receive love in acts of familial (and civic) friendship, a concept with profound Aristotelian roots. All suicidal ideation must be perceived as a mental health crisis deserving rehabilitative treatment. As we contemplate America’s mental health crisis in the new year, we would do well to consider Snead’s words: “The law should encourage and offer care, not open a pathway to suicide by transforming the healing art of medicine into a handmaiden of death.”

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