Making Choices During December in 2016, one of my grandsons chose to end his life. Suffering from a deepening depression, and other difficulties, despite the efforts of parents, companions and health professionals, with forethought and efficiency, leaving a message taking full personal responsibility for his act, my grandson took his own life. He was twenty-three years old.

He could have no conception of the pain and suffering he was leaving behind among the living, as he sought to end his own, perhaps thinking to alleviate the burden his condition had placed on the people he cared for. We cannot ever really know but it is possible he was no longer able to tolerate the prospect of a continuing failure to live up to his own expectations for himself. He could not imagine the fears his actions could evoke that there could be copy-cat contagion, familial implications, the incredible gamut of sensibilities that such an act arouses. Inevitably we are heirs to all the second-guessing of coulda-shoulda-woulda that those close to him torture themselves with, guilt-ridden, when examining their souls.

Why could we not disrupt the trajectory of lethal despair, mounting, consuming the natural desire we all have to continue living our lives? Hopelessness hardened into an unalterable resolve. Intellectualizing the event does not eliminate the emotions we will live with as long as we ourselves are alive. I am wracked by feelings of sorrow, anger and frustration. There is nothing and no-one to blame. But, this is not just about me. If I feel this, how much more must the pain be great for parents and siblings. That compounds my distress.

The Jewish rite allows scope for the full expression of grief after a death for a week, during which time the whole community rallies around to provide sustenance, housekeeping, acts of presence and support. Afterward there are a series of acts to be carried out, after a month, three months and a year. By the end of the year a stone is placed on the grave with an appropriate inscription and a memorial held. It is a religious injunction that life must go on as before, with an annual memorialization on the anniversary of the death. It is hard at this time to imagine how life can go on for us as before, but in most respects it will.

In North America, and in some countries in Europe, there is a growing acceptance and legalization that individuals have a right, under certain conditions, to terminate their own lives. Often, these deaths occur to alleviate unalterable pain with no prospect of relief, conditions of terminal illness with no cure, instances when the body continues to function with no apparent brain activity. Most organized religions condemn the act as contrary to the deity’s will and subject to sanction. But these are actions we can rationalize and understand. A life without the possibility of joy is indeed difficult to bear. These things occur even naturally. How often do partners losing mates quickly pass when they have lost their partners, not willing in their minds to continue to live without sharing their lives with a beloved.

In this era of institutional responsibility for health, we note what is termed “benign neglect” in hospitals and doctors’ offices, for the aged and seriously-ill patients in the latter stages of their lives. Sometimes it is the government institution, or one that is government-supported, that acts to terminate life by withdrawing life-sustaining care and medications. Failing private means, these are death sentences. In these cases our power of choice has been delegated to others who have no emotional stake in our survival. I cannot restrain my rage at the inherent loss of control we are facing through what we would otherwise consider positive developments in our society. I wish we could always retain such choices for ourselves to make.

Suicide is a world-wide phenomenon. With all the challenges and disappointments we must face, seeming unsurmountable at times, who can assert that they have not had such thoughts at some time in their lives. The suicide rate reported in Israel, where my grandson resided is, by some estimates, about 10 per 100,000 of population, compared with more than 18 in the United States. The rate is lowest in some South American countries. Suicide rates are many times higher in Russia and some countries of Eastern Europe. On a world basis, suicide accounts for more deaths than those from wars and terrorism. In America, those aged between 45 and 64, as well as those over 85, (at close to 20 per 100,000) have the highest rates of the incidence of self-inflicted death.

Those who have faced this tragedy, particularly so, when they have lost young people with the full scope of life ahead of them, know something of the road that lies ahead of us. Consequent on the choices made by others we may care for deeply, we are forever vulnerable. In the midst of our daily lives to come, chance triggers will evoke our loss. Grief stalks us from the shadows like some wild beast. When it strikes us, fresh and raw, like emanations from an open wound, we will feel again the waves of pain and regret like those I feel today. I believe we must hug those occasions to ourselves, hurtful as they necessarily may be, and welcome them as an opportunity for the lost one to live again in our minds. And we will be reminded to be more wary and sensitive to signs in those around us that we care for that should earn our close attention.

Let truth and justice prevail!