All Commentary
Monday, January 1, 2001

Book Review ~ Fatal Freedom: The Ethics and Politics of Suicide by Thomas Szasz

Praeger • 1999 • 177 pages • $25.95

Thomas Szasz and his work need no introduction to a libertarian audience. A physician and psychiatrist, his love of liberty has always outweighed his love of medicine, and he has become one of the great opponents of the medicalized loss of liberty known as the Therapeutic State.

Szasz’s 24th book attacks yet another sacred cow of the modern worldview that crushes personal autonomy under the guise of expert therapeutic intervention and mandated “helpfulness.”

Some background: Szasz takes liberty, responsibility, and autonomy seriously. If mental illness is, as other psychiatrists tell us, “a disease like any other,” Szasz asks why imprison schizophrenics against their will when we don’t imprison diabetics against their will? Szasz argues vociferously for the liberty of those labeled mentally ill. If, as Thomas Jefferson argued, men have as much right to ingest what they wish as they have to think and believe what they wish, why, asks Szasz, do we fight an unwinnable war against drugs? He has long been an advocate of the right to ingest or inject whatever one chooses (insisting also that those who do so take the responsibility of any consequences that follow). He has, however, not been an advocate of medicalizing the war on drugs, seeing this as just another effort to aggrandize physicians while infantilizing the masses.

In his latest book, Szasz advances his defense of autonomy and liberty by speaking out for the right to suicide.

Our final freedom is the fatal freedom, the ability to control our deaths, just as we attempt to control (and are typically granted the right to control) our lives. Szasz explores the history of suicide, from a sinful act to a symptom of mental illness to an alleged “right” under the control and auspices of medical experts.

In past centuries, the successful act of suicide allowed religious authorities to prohibit religious burial and political authorities to confiscate the suicide’s property. More recently, failed suicide justified involuntary confinement in a mental hospital. Now the desire for suicide is alternatively seen as evidence of disease if acted on by an individual but as a sacred right if handled through the intermediary of a physician.

Szasz will have none of this.

Death control, like birth control, requires medical knowledge but is not a medical matter. It is a moral matter, and should in a secular society be under the control of the individual. In the twentieth century, birth control was initially illegal, then for a time available only by physician prescription. Now it is seen as a right, to be handled autonomously, not via physician-assisted birth control. Analogously (and for those who have not yet had the pleasure, be aware that Szasz is the master of analogy), if adults are to be free and autonomous, they need to obtain control of their deaths, not be placed in the position of medical mendicants, trying to please the authorities with the right combination of signs and symptoms, complaints and conditions that “justify” physician assistance in ending their lives.

More darkly, Szasz warns, the “right” to suicide, if viewed as a medical intervention, can lead—especially in a society where the access to health care is controlled by the state—to unintended consequences. Like the person held in a mental hospital who wants nothing more than to leave but is told instead that he has a “right” to treatment that will be given to him like it or not, the elderly and sick in socialist countries risk being told they have a “right” to suicide, like it or not. Hard to believe? Read chapter six, “Perverting Suicide: Killing as Treatment.”

Though a medical practitioner, Szasz is not in the habit of prescribing for others. A right to suicide is not an expectation that, as everyone grows old, each is expected to “take care of matters” before they become a nuisance. It is instead a matter of options and the consequences for society of not having options. As Szasz writes,

Therein lies the most insidious danger of relying on external prohibitions to regulate behaviors that can, in the final analysis, be effectively regulated only by internal controls. If young people believe that they cannot, need not, or must not control how they procreate—because assuming such control is wrong (sinful) and/or because others will assume responsibility for the consequences of their nonaction—then they are likely to create new life irresponsibly. Similarly, if old people believe that they cannot, need not, or must not control how they die—because assuming such control is wrong (a mental illness) and/or because others will assume responsibility for the consequences of their nonaction—then they are likely to die irresponsibly.

Legally protecting suicide is not synonymous with advocating suicide, any more than desiring legal protection for birth control implies advocating that people use birth control. Further, legally protecting the right to suicide no more mandates physician involvement in and control over suicide than birth control today, rigidly controlled by physicians in the early part of the twentieth century, requires continued physician involvement in prescribing it and counseling on its use. Physicians have no monopoly on wisdom into the human condition, and creating medical mandarins does not make them wiser. As with most monopolies, more likely the opposite.


Tom Szasz has written many provocative and courageous books. He has done so again.

Ross Levatter is a radiologist in private practice in Green Bay, Wisconsin.