CW: mental illness, suicide, rape

 We all know how bodily autonomy is a central aspect of feminism. From abortion access to consensual sex, women have fought for decades for the right to make decisions for their own bodies. As Margaret Sanger once said, “No woman can call herself free who does not control her own body.” Is a woman less free, then, if she doesn’t have the right to die? 

 Many pin the beginning of the "right-to-die" movement to the 1975 New Jersey Supreme Court case of In re Quinlan. The court ruled that the parents of Karen Ann Quinlan, a 21-year-old woman determined to be in a “persistent vegetative state,” were allowed to order her removal from artificial ventilation. This landmark case ushered in a mediastorm, which continued with other notable right-to-die cases such as Terri Schiavo and Brittany Maynard. The debate has been particularly well covered surrounding cases involving women, as noted in Erica Eisen’s Lady Science article “Do Women Have a Right to Die?”  

 In 1996, Susan M. Wolf, a professor at the University of Minnesota Law School, offered new insight into how gender impacts the U.S. debate over the right to die with the paper "Gender, Feminism, and Death: Physician-Assisted Suicide and Euthanasia." She notes that women are more susceptible to factors that affect a patient's consideration of the practice, such as depression, lack of pain management, and difficulty obtaining quality healthcare. 

 The right-to-die debate has become more complex, however, with the introduction of mental health issues. In 2016, it was falsely reported that Noa Pothoven, a Dutch teenager, had died via legal euthanasia. The young woman had struggled with post-traumatic stress disorder (PTSD), depression, and anorexia, and she ultimately died after she stopped eating and drinking. Nevertheless, it brought media attention to the fact that psychiatric euthanasia is in fact legal in the Netherlands. The Dutch Penal Code Articles 293 and 294 state that a legal euthanasia must include the following guidelines: The patient must be experiencing unbearable pain; there must be no other reasonable solutions to the problem; and the death request must be voluntary. The law further states: “[T]he patient’s death request must be enduring (carefully considered and requested on more than one occasion).”

 In theory, a mental illness can meet these stipulations. Studies show that PTSD can in fact last a lifetime, such is the case with Holocaust survivors. Persistent depressive disorder, also known as dysthymia, is a form of chronic depression that affects approximately 1.3 percent of adults in the U.S. For countless individuals, it can feel like there’s no escape from chronic mental illness. 

 In 2016, Adam Maier-Clayton, a 27-year-old Canadian, requested a medically assisted death due to significant mental illness. In an essay published in The Globe and Mail, he described his battle: “I’m not suicidal in the sense that I hate myself and I want to leave. I think this world is beautiful, but this amount of pain is intolerable… Some people are confined to lives of truly horrifying amounts of suffering that no amount of treatment can stop.” His request was denied, and he died by suicide in April 2017.

“Right-to-life supporters are very much in favor of keeping women alive, but quality of life isn’t on the agenda.”

Mental health issues in the right-to-die movement become particularly nuanced, however, when viewed through a feminist lens. In the case of the Noa Pothoven, she had post-traumatic stress disorder (PTSD) stemming from sexual assault. In fact, 13 percent of American women have been raped, and 31 percent of rape victims will develop PTSD. Therefore, 3.8 million female survivors of rape have PTSD in the U.S. Additionally, women are twice as likely to develop depression than men as well as an anxiety disorder. 

 On top of the disproportionately high number of women who battle mental health issues, there is a large discrepancy when it comes to the treatment of these women. Several studies have revealed a gender gap in healthcare, ranging from a misdiagnosis of endometriosis to lesser care of dementia. Unsurprisingly, a gender gap exists in mental healthcare as well, particularly in terms of access to safe and affordable treatment. 

Mental illness doesn’t need to be a death sentence. In certain scenarios, it can be preventable, especially in terms of PTSD resulting from sexual assault. Sexual assault is undoubtedly an epidemic: one in five women will be raped at some point in her life, compared to one in 71 men. Additionally, rates of depression in adult life are three to four times higher in women exposed to childhood sexual abuse or physical partner violence in adult life. While PTSD is an excruciating battle, misogyny may have led women to this life in the first place, from the initial rape to society's unwillingness to believe her. A 2016 meta-analysis of studies examining unacknowledged rape found that only five percent of sexual assault incidents were reported to the police. One of the top three reasons was "fear of not being believed.”

Those who oppose the right-to-die movement need to be just as adamant about a woman’s right to a life unmarred by sexual assault as well as dismantling a patriarchal society that keeps women poor and sick. Unfortunately, this isn’t the case. Right-to-life supporters are very much in favor of keeping women alive, but quality of life isn’t on the agenda. It parallels the anti-choice movement; those who oppose abortion should instead be working towards comprehensive sex education and birth control, not to mention a deep concern for children detained in immigration camps. 

Yes, a woman absolutely has a right to die if she is terminally ill with six months to live. But a woman also has the right to adequate mental health care, and to live a society that believes her when she’s been raped, or to be treated by a doctor that doesn’t dismiss her symptoms. In the end, can we erase a woman's desire to die by offering her better mental health care? Can we dismantle a patriarchal system that leaves her with more options than death?