Assisted Suicide and Trans: Being Our Authentic Selves to Death

The parallels between the assisted suicide movement and the transgender movement are staggering. I’ve followed the work of journalist Rupa Subramanya for some time now and every time she writes about assisted dying, I read her articles with great interest. Her April essay for The Free Press hit close to home because Zoraya ter Beek, the woman at the centre of the article, is from a country that is close to my heart: the Netherlands.

The Netherlands: A Nation of Pioneers

This country has been at the forefront of both of these movements. This is probably not surprising to anyone who has spent time there. This is not the place for a history lesson, but suffice it to say that there is something in the Dutch character about not necessarily intervening in certain matters. Some of it probably has to do with the types of Protestantism that flourished in the country centuries ago; its outward-looking economy; the value placed on pragmatism and on “being normal” (doe gewoon—’act/be normal’—is somewhat of a national motto). These social tendencies broadly translate into Dutch society being tolerant of people’s lifestyles with the understanding that there is cooperation for the common good and that your private matters will not negatively affect others. This is not to say that there aren’t any tensions in society or factors that threaten the social contract. However, the Netherlands has for a long time been extremely tolerant of fringe ideas and ways of life. This environment grants radical movements like the assisted suicide and trans movements a neutral to positive arena in which to develop. It is perhaps not an accident that this country has been a pioneer in both assisted suicide and medical interventions for gender-related issues. It was, after all, Dutch clinicians who, over 25 years ago, “proposed puberty suppression as an intervention for ‘juvenile transsexuals,’ which became the international standard for treating gender dysphoria”. This treatment process came to be known as the Dutch protocol. The Netherlands was also the first country in the world to legalise voluntary euthanasia and physician-assisted suicide back in 2001.

While the Netherlands gave way to these movements, both of them have spread far beyond this small Western European nation.

A Global Movement

Both the assisted suicide movement and the trans movement are global. Subramanya’s article mentions how the movement has pushed its way across not only Europe, North America, Australia, and New Zealand but also into Latin American countries such as Colombia, Ecuador and Cuba. The trans movement has done something similar, pushing its way across Western nations but its reach, as I outlined in a previous article for Genspect, goes far beyond wealthy, industrialised Western nations.

This is important because as Subramanya puts it:

All this has raised questions about whether the right-to-die movement—which has gripped much of the West—is really about self-empowerment, as its supporters insist, or whether it points to something darker eating away at our civilizational fabric.

My money is on the latter—both the advancement of the assisted suicide movement and the trans movement point to something darker. Let’s be clear, I am not saying that there is a grand conspiracy with shadowy figures controlling what happens. My argument here is that both of these movements propose a radical way of looking at humans and that they stretch ideas of self-determination, self-empowerment, autonomy and authenticity to their most radical (yet logical) conclusions. Both movements seek to liberate us from suffering through radical and irreversible interventions. Both are seeking greater social acceptance and normalisation. Both are couched in euphemistic language that obscures what is really happening. Both are subject to social contagion. And both are facilitated by the medical community—although assisted suicide activists want to de-medicalise the process (we’ll get to that).

The Normalisation of Radical Interventions

One important area of exploration when comparing these two movements is the ever-widening scope. We have all heard about the unbearable situations in which some people can find themselves—terminally ill patients who go through unbearable pain and suffering and who would rather make arrangements to die in a way that will mitigate their suffering. I am certainly sympathetic to the plight of these people. And they are always at the forefront of discussions of euthanasia and assisted suicide. However, the scope has increasingly expanded. Subramanya has written about the MAiD programme in Canada and in the article about Zoraya ter Beek’s scheduled suicide, her focus is on how activists within the right-to-die movement want people with mental illness to have access to assisted suicide. Some countries are far beyond the extreme cases of terminally ill patients wanting to die with dignity. The similarity to the transgender movement comes in if one considers the expansion of the scope, and suicide and transition as the processes that are facilitated by medical professionals. The interventions (hormonal and surgical) involved in transitioning used to be rare occurrences for people who had what can be considered chronic gender dysphoria. They were adults making that decision with their doctors and the rest of society was largely unaffected by the decisions of these individuals. What has happened in the last few decades is an expansion of the scope and a reframing of the problem. No longer restricted to adults, transition is offered to children and adolescents as a solution to a vast array of mental health and emotional problems that have become entirely channelled into gender. And this does not start at the therapist’s or doctor’s office—the idea of being trans has exploded in popularity, it is a cultural phenomenon and a belief system. It offers people a compelling idea: you can be someone entirely new; you can change the sex you were “assigned at birth” thereby becoming your “authentic self”, and then you’ll finally feel like you belong. The trans movement sells the idea that in order to be at home in your body you need to radically change it (or at the very least tweak it by microdosing hormones). It is a message of liberation from the flesh. And this is where assisted suicide comes in, for what is more liberating than ending the body? Here is ter Beek on a tattoo she has:

‘Where the tree of life stands for growth and new beginnings,’ she texted, ‘my tree is the opposite. It is losing its leaves, it is dying. And once the tree died, the bird flew out of it. I don’t see it as my soul leaving, but more as myself being freed from life.’

This statement raises the question of what “self” she is referring to as being “freed from life”. She knows, however, that this is final: “I’m a little afraid of dying, because it’s the ultimate unknown.” At the very least the activists in the assisted dying movement have not started telling anyone that death is reversible, but I wouldn’t be surprised if they started trying to popularise the possibility of “living on” as a disembodied consciousness in a virtual space—the “self” can be then freed from life in the body but live on virtually, entirely happy and unburdened by the pain of being human.

Subramanya interviewed Theo Boer, a healthcare ethics professor who served on a euthanasia review board: “I saw the Dutch euthanasia practice evolve from death being a last resort to death being a default option.” In the article, Subramanya describes how the people looking to assisted suicide as an option now include young people who are suffering from depression and anxiety made worse by things like economic uncertainty or climate change. Autism is also mentioned. This mirrors what has happened in the transgender movement—distress arising from a wide range of sources has been channelled into gender, scores of young people are adopting a set of beliefs, chief among them that transition is the solution to their distress, and there are medical professionals who are ready to facilitate irreversible interventions.

Medicalisation and the Consumer Mindset

When it comes to medicalisation, the transgender movement and the assisted suicide movement share some characteristics, but the latter is pursuing de-medicalisation. The transgender movement needs the complicity of medical professionals, at least when it comes to access to interventions. Mental health professionals may become redundant since there is ever-increasing pressure for fewer gatekeepers on the way to hormones and surgery. The assisted suicide movement’s battle against gatekeeping extends to the point where a Dutch group called Coöperatie Laatste Wil or Last Wish Cooperative (CLW) would like to see:

[C]heaper, easier to access assisted suicide. One day, if CLW has its way, everyone will have suicide kits—including sodium azide pills, painkillers, anti-nausea tablets, and sleep aids—in their medicine cabinets. The kits will be readily available at the local pharmacy, grocery store, or on Amazon. (To ensure toddlers can’t pop sodium azide, each kit will come with a fingerprint-identification lock).

This is their vision and it strikes me as perversely consumer-focused. The trans movement does not want to get rid of medical professionals, mostly because it can’t, but it can ensure that the professionals practising in this area of medicine are gender identity believers and activists (or perhaps detached “service providers” who want to help people achieve their “life goals”). This is evident in the way WPATH members in the WPATH Files discuss “non-standard” surgeries, such as mastectomies without nipples, nullification, and phallus-preserving vaginoplasties (see pages 152-160 in the WPATH Files). This mindset of medical professionals either being out of the way or being simply activist service providers catering to consumer/patients’ whims—rather than healthcare professionals who work within an ethical framework—also maps onto how these discussions are happening online among potential “consumers”. In a Reddit post titled “What body do we want?” from r/NonBinary, Reddit users describe their vision for the “non-binary body”: a shape-shifting body that changes based on the person’s feelings. Fangs, pointy ears (without affecting hearing), a tail, detachable boobs and other, graphic, descriptions of made-to-order genitals are described. These are the impossible interventions, but there are also people who describe what they currently do to customise their bodies: microdosing hormones to get an androgynous physique, booking a total hysterectomy to get rid of periods. They also discuss what happens at an appointment with a surgeon who is willing to perform “non-standard” gender surgeries:

That’s about it, basically they consult with you about your ideas and find something that is close with as little medical concerns as possible. One I looked into alters the labia to be less present and creates a covering for the clit so you’re left with just the fun part lol there’s non penis shaped phallus appendages they just try to cause as little nerve damage as possible and keep the urethra intact. No pictures just that basic outline and a note to discuss it with the surgeons.

There’s also partial breast augmentation/partial mastectomy, nipple less with no reduction nipple less with augmentation customizable nipple shape, size, and placement. Not every surgeon listed this but some of the more in demand ones did.

It may appear as though the trans movement and the assisted suicide movement are going in different directions on the medicalisation front, but in reality, they are parts of the same game. If we see this as a videogame, the trans movement is the part where you customise your character to your liking and the assisted suicide movement is the moment where you “exit the game”. In a videogame, all of these things happen on your own terms; you get bored so you change your character’s look. You can have the pointy ears, you can have the tail, you can have detachable parts and you can exit the game whenever you want.

The trans movement pushes people towards the medicalisation of their identities and the assisted suicide movement wants to “liberate” them from it. Philip Nitschke—interviewed by Subramanya—is the creator of a suicide machine called Sarco, which he views as “part of a reimagination of the inevitable—liberating ‘prisoners of medical treatment’ from ‘Western technological medicine.’” This raises the question of what happens to the countless people who are being sent down the path of transition and becoming medical patients for life in an environment where giving up on life is becoming increasingly acceptable and with a rising movement that presents suicide as the ultimate solution to suffering. How many of the young people who today are caught up in believing that transitioning will help them solve their problems will one day wake up and realise that, actually, transition didn’t help, but that suicide—given its increasing acceptability and romanticism—might well do the trick?

Language and Romance: Camouflaging Tragedy

Theo Boer, the bioethicist, warns that using euphemistic language with regard to suicide camouflages what we are actually talking about here, which is that people are saying to their doctors, “I want to be killed”. The euphemistic language employed by the assisted suicide movement includes: assisted dying, completed life, and euthanasia. There are also other ways of speaking about suicide euphemistically for other reasons, such as not getting banned on social media—creators on YouTube employ a range of phrases and words to refer to suicide and other sensitive topics to avoid a ban: unalive (yourself), exit game, unplug. People are very creative with language. Arguably, both of these strands of euphemistic language have a similar effect: to camouflage what is happening. There are good reasons not to casually talk about suicide, not least because suicide contagion is a real thing. But we should not allow activists who promote the assisted suicide movement to define the contours of the conversation and further couch this act in pleasant-sounding, almost romantic language.

Something similar happens within the transgender movement. Radical interventions are rephrased: mastectomies are “top surgery”, vaginoplasties and phalloplasties are “bottom surgeries”. There is a gender surgeon in Florida who casually talks about removing teenagers’ breasts as “yeeting the teets”. Both movements seek to romanticise the interventions and to reframe the various disappointments people experience as being part of a “journey”.

The assisted suicide movement uses words such as mercy, dignity, humane dying, peaceful, rest, completed life, bowing out. While the transgender movement uses the language of authenticity and feeling comfortable in one’s body, and increasingly the language of transcending the body—the body is a vessel, a suit, a customisable “meat prison”. Both of these movements emphasise freedom, autonomy and a state of comfort and happiness. Both of them romanticise the interventions. Subramanya briefly dives into the trend of “duo euthanasia,” in which a couple kills themselves at the same time à la Romeo and Juliet. The trans movement is rife with emotional stories of children and adults whose world opened and whose suffering ceased when they realised that their inner self was trans and that through the pursuit of medical transition they would finally become their true selves and be comfortable and happy. Neither of the movements deliver on their promises. Medical transition is a “journey” to nowhere. It does not lead anyone to become the opposite sex or non-binary—simply because neither of these outcomes is possible. Meanwhile, the challenges that the person transitioning faced before transition remain. The assisted suicide movement may liberate the person who dies from pain, but the pain is passed on to others; those left grieving the person who left and our society, which as it condones giving up on life displays, in Theo Boer’s words, a “poverty of spirit”.

To return to that darker thing eating away at our civilisational fabric, it seems there is a compelling argument to look at both the trans movement and the assisted suicide movement as parts of a whole—one feeding into the other. Both propose irreversible interventions as solutions to distress. Both are gaining popularity among younger cohorts of people who are alive at a time when there is a mental health crisis. Both transition and assisted suicide activists frame these interventions as “journeys”. As assisted suicide activism advances, both of these interventions may become part of the same tragic journey.  

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Photo by RODRIGO GONZALEZ on Unsplash