On the Ethical Dilemma of Suicide in Longevity as Sacrifice for the Social Ideal Volume 62- Issue 5

Tomáš Hájek**

• Sexological Society of J.E.P. Czech Medical Society, the Economic and Social Council of the Most Region

Received: July 29, 2025; Published: August 04, 2025

*Corresponding author: Tomáš Hájek, Sexological Society of J.E.P. Czech Medical Society, the Economic and Social Council of the Most Region

DOI: 10.26717/BJSTR.2025.62.009807

Abstract PDF

This text is written on the basis of medical and philosophical sciences at the same time. The wording therefore applies precise medical terminology, while making use of the terminological freedom offered by the current philosophy, where metaphoric thinking is utilised.

Psychiatry uses several models to explain mental disorders: the psychosocial, organic, agnostic (atheoretical), and drug-like model. Two basic categories of suicide are described – balancing suicide, where the motivation for suicidal behaviour stems from reality, and pathological suicide, which is essentially caused by psychopathology [1]. Pathological suicide is the primary focus of medical studies and the opinions differ, based on parallel existence of several models explaining mental disorders. However, opinions on balancing suicide may also differ, as the key philosophical questions cannot be definitely answered; for example, the most basic of questions, whether the world is monistic, dualist or pluralist and in what sense. From the medical perspective, specifically in psychiatry, the topic of suicide is by principle an open issue that cannot be concluded with any definite knowledge.

This text is written as a form of introduction to the topic and focuses on suicide in continued longevity, which strives to prevent discrediting longevity by the loss of individual powers of intellect in the bearer of longevity. It is therefore clear that the text perceived longevity as a positive social value and evidence of the presence of the universal Good. In this sense, longevity, although attributed to an individual, has parameters of a universal moral value; an individual in longevity being responsible for themselves assumes much wider responsibility. It is obvious that balancing suicide is the only type of suicide subject to consensus among most psychiatrists and thus the only type of suicide applicable for the interpretation of this case. This text studies a special shade of balancing suicide, reaching beyond the strict medical definition of suicide and focusing on sacrifice for the social ideal. Naturally, even suicide as sacrifice for the social ideal is subject to assessment criteria of medical thinking and pathological behaviour. Balancing suicide is a way of resolving an exceptionally difficult or even hopeless situation, in which an individual concludes that it is better that they no longer live, not only for themselves, but also for the others. It also tends to be considered a socially acceptable form of utter social debacle. Psychiatry is not united in the question of whether the decision to commit balancing suicide is always somewhat pathological. Suicidal behaviour is not entirely socially acceptable for deeper reasons.

The topic of pathology of suicide as sacrifice for the social ideal is even further for psychiatry than the topic of pathology of balancing suicide; psychiatry cannot reach general consensus on non-pathological character of balancing suicide and the same consensus is utterly impossible in the case of suicide as sacrifice for the social ideal. However, cooperation between medical and philosophical sciences may bring some progress in this topic. While philosophy can hardly judge the pathological or non-pathological character of balancing suicide, it is capable of explaining the non-pathological character of suicide as sacrifice for the social ideal.

The key principles of stoic philosophy are: systematic approach, identification with the nature and cosmos, cosmopolitan approach, everything is subject to fate, rational approach is the only way of reaching contentment, ethics are the fruit of philosophy. In stoicism, which influences almost entire Hellenistic philosophy, the Greek theoretical excellence is combined with the Roman practical approach; it should also be noted that Poseidonios, Epictetus and Seneca as representatives of stoicism are highly valued by Christianity. Stoic philosophy has left a major mark in the history of ethical thinking by making clear distinction between ways of seeking virtue, which essentially is the meaning of the human life, and everything that can be described as adiaphora – indifferent things. The length of one’s life is also adiaphoron, which means that achieving longevity is entirely insignificant; after all, a human being has nothing else than the fulfilled presence. Suicide therefore is a practical act and evidence of the necessity to maintain rational virtues as the meaning of life and all else is adiaphoron. It should also be noted that the affirmative approach to suicide in particular in the early stoic thinking derives from the stoic notion that the world is unchangeable; to the point that identical historical figures appear in historical cycles between two conflagrations. Suicide therefore is mere cancellation of the formal existence in copies in the cyclic timelessness.

Zeno of Citium therefore commits suicide, or to be more precise, commits programmed suicide as sacrifice for the social – stoic ideal, as every sincere stoic is in some sense obliged to commit suicide. The above-mentioned stoic ideal is the knowledge that acting in line with rational virtues is essential, all else is adiaphoron [2]. However, as stoic philosophy gradually developed, so did its approach to suicide. Middle stoics, Boethus of Sidon, Panaetius of Rhodes and Posidonius of Apameia turned away from the radicalism of the founders; from the cosmological point of view, the world is eternal according to their thinking, but is no longer subject to conflagrations, i.e. global fires that determine the world’s existence in cycles. The departure from radicalism of programmed suicide in developing stoic philosophy is probably partly due to new perception of time delivered by Judaism and Christianity. As the concept of historical salvation appears and the notion of time ceases to be cyclic, the new adiaphoron has to be different from the former adiaphoron. The fact that certain things are indifferent remains the same, but the definition of what is indifferent changes. Programmed suicide of a noble stoic thinker becomes adiaphoron, but programmed mass sacrifice for faith is not adiaphoron. The stoic philosophical contextualisation of suicide is philosophically so persuasive that it becomes apparent from the stoic systematic philosophy of individual and social meaning of suicide that suicide as sacrifice for the social ideal may be non-pathological.

However, it is necessary to point out that the ancient Greek philosophical thinking perceives suicide in various ways; for example, Pythagoreans on the one hand refuse to attribute any positive moral value to suicide, while, for example, post Socratic school of cynicism on the other hand assesses suicidal behaviour at least neutrally. Stoic philosophy, for example in Seneca’s late perception tends to be assessed almost as pathological affirmation of suicide [3]. Mentions of libido moriendi appear [4]. However, the author of this paper is of a different opinion. The topic of historical salvation is decisive. While it is not expressly described by stoic philosophers, its presence in the thought climate of the time indirectly makes their deontology persuasive. The above-mentioned libido moriendi shows how philosophical individualism is dissolved in the persuasion that the collective sacrifice for salvation makes sense, instead of the notion that it should be perceived as a symptom of a civilisation in agony.

First of all, it is necessary to note that this ethical contemplation is speculative, but legitimate in philosophy, considering the above. Decision making in ethics always involved at least dichotomies, and sometimes decisions are even more complex. Longevity as the basis of this contemplation is considered by the current geriatrics to be age 90+. There are two options for viewing this situation. One can either apply the stoic approach, according to which age is indifferent, it is adiaphoron, or perceive time as the history of salvation. If longevity is adiaphoron, the issue of balancing, or more precisely programmed suicide in longevity as sacrifice for the social ideal is non-existent, because longevity has no special moral value. The fact that it has occurred says nothing about the life the individual has lived so far. The life may have been lived well and may yield its fruits, but it may also have been the opposite. This longevity is époché, refraining from judgement. Alternatively, longevity may not be adiaphoron, it may not be époché. Instead, it may be the evidence of the quality of life, a stamp, a publicly communicated and comprehensible symbol. Therefore, it is very special time and perhaps it is not even time. Perhaps longevity is a stamp of good life, a space between physics and morality; time is measured in the same way as before longevity, yet the matrix is different. This is a moral matrix. Longevity says: the history of salvation continues and nobody knows what the culmination will be. However, I as an individual have done everything I could to make sure that time is qualitatively distinguished, that it does not run in cycles and that it has its meaning.

By definition, longevity should be eternal, as a symbol in its power to represent is also everlasting. This introduces the following peculiar paradox: an individual that reaches longevity should live forever. However, empiric data shows that this is not the case. Longevity, which should be eternal, is affected by incurable and at the same time chronic disease (the chronic aspect being highly significant), which gradually ends longevity. Dementia is particularly dangerous among these diseases, as it not only ends something that should be everlasting, but also discredits longevity by destroying reason and memory as the means for uniting the multitude of lived present moments into a single coherent life. A human life cannot be lived without reason and memory. What ethical dilemma is posed by this situation and is it possible to find any conceptually clear solution to this?

a) Judaism and Christianity defend the perception of time as the time of salvation; at the same time, neither of these religions commend the approach of stoic philosophy which calls for voluntary departure as an ideal by which a wise man confirms his approach to the world and thus also himself.

b) The same principle that unlocks longevity as a universal moral value therefore at the same time prevents an individual experiencing decline of cognitive capacity in continued longevity from protecting longevity as a universal moral value from being discredited and ending their life voluntarily.

c) However, there is another option available: if an individual considers longevity to be a universal moral value and at the same time is concerned about discrediting this value with the decline of their cognitive capacity, while being prevented from ending their life voluntarily by their religious faith, they should seek help in publicly available instruments for ending an individual’s life, which has changed into a universal moral value. Requested active euthanasia or medically assisted suicide are the public instruments referred to above, not only as technical procedures, but also metajustification behind these instruments.

d) Resolving the tragic paradox in which something that should be eternal does not last forever is the responsibility of the society as a whole. It would therefore appear that suicide in longevity as sacrifice for the social ideal is not an ethically correct decision, because this difficult task should be resolved by active requested euthanasia or medically assisted suicide; the society should be ready to help. The society should not leave an individual that has walked a long path to make one of the most difficult decisions – a decision on behalf of the others and for the others.

e) The author of this paper is of the opinion that the topic of active requested euthanasia has been a highly disputable and at the same time static phenomenon over the last decades, and this issue has been accompanied with other major topics, such as medically assisted suicide, or particularly complex, topical and dynamic issue of therapeutic inactivity towards the end of live in the sense of withdrawing medical treatment, withholding medical treatment, or hastening death as a consequence of palliative treatment of pain. The author of this paper is not an advocate for active requested euthanasia or medically assisted suicide. However, his ethical contemplation of a specific morally complex situation in longevity burdened with dilemmas bring the author to the issue of the societal responsibility for a universal moral value, which is concealed in individual decision making in a specific ethical situation, and at the same time can be interpreted vastly differently in various philosophical approaches.

f) A decision to apply active requested euthanasia as an instrument needed for protecting longevity as a universal moral value from being discredited mainly by declining reason of the bearer of longevity faces a major problem or obstacle when analysed ethically. According to the so-called Rotterdam criteria, for active requested euthanasia to be tolerated in this specific situation (quote), the patient must be enduring intolerable suffering (not necessarily physical) and euthanasia must be the last option. All other options for alleviating the patient’s situation must have been exhausted and found ineffective. [5]. Preliminary ethical consideration would suggest that medically assisted suicide is clearly a more acceptable option, which still requires a much detailed analysis. Yet, the author of this paper believes that it should not be applied. At least this is the conclusion reached so far at this specific point of analysing this topic. Why?

g) The paper essentially concludes that a decision with regard to suicide in longevity as sacrifice for the social ideal has to be at the discretion of the relevant individual, regardless of the immense difficulty of this situation. The character of this autonomous decision making by an individual can be depicted more detail through comparison of suicide in longevity against the so-called ageist suicide. Ageist suicide is undoubtedly a highly complex phenomenon appearing in civilizational atmosphere where increased energy is spent on seeking new, modern methods in ars moriendi, the art of dying, and where the society seems to be losing its biophilic orientation. The following quote concerns ageist suicide: “We all know that the numbers of the elderly in modern societies increase significantly. Many elderly people justly fear loss of self-sufficiency and full dependence on other people. Statements that constant professional care for these people is very expensive and care provided by non-professionals is exceptionally burdensome are heard repeatedly in the public space. Is it possible that even seniors may start thinking about “elegant” ways of killing oneself to make sure that they are not burden primarily for their loved ones, secondarily for anonymous carers and ultimately for the society as a whole? After all, the 104-year-old Australian scientist David Godall underwent the so-called ageist suicide in Switzerland on 10/05/2018. The Czech media reported on this event, publishing his final message: As soon as an individual is over fifty or sixty, they should freely decide whether they want to keep living or not [6].”

h) Suicide in longevity as sacrifice for the social ideal differs from ageist suicide, as in this case the autonomous space for an individual’s decision making is influenced by biophilic orientation; the individual in longevity no longer belongs to themselves, they belong to the society, the humanity. When they decide to undergo suicide in order to prevent longevity and thus the sense of history from being discredited, they essentially decide also on the society and humanity in the sense of certain moral Kantist maxim. In addition, an individual in their longevity knows that the society cannot help them. Or more precisely, that they cannot request any assistance from the society, regardless of the fact that they belong to the society and essentially decide on the society through their action. Their decision on suicide in longevity as sacrifice for the social ideal is therefore “technically” more complex and this is the evidence of the generally contradictory situation, which still needs to be resolved. However, this contradiction is reflection of the moral greatness of an individual’s task. A morally great task (while trying to avoid pathos as much as possible) should always stem from the deepest autonomy of an individual. To use a metaphor, this autonomy should be so deep that the individual combines with the timeless in this depth. The discussion above shows that suicide in longevity as sacrifice for the social ideal is in agreement with religious faith, despite the fact that religions nominally reject suicide.

None.

No conflict of interest.

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