A Philosophical Spark about the Fragility of Existence: A Response to Vincenzo Di Nicola

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When I read Vincenzo Di Nicola, MPhil, MD, PhD, FCAHS, DLFAPA, DFCPA, FACPsych’s article article in Psychiatric Times, “Socrates’ Choice: A Philosophical Perspective on Euthanasia, Suicide, and Assisted Suicide,” which speaks of “the value of life, the morality of death, and the role of individual autonomy in decisions regarding one’s own existence,” I was drawn into a debate that ignites controversy and deep introspection.¹ Euthanasia—the deliberate act of ending a life to relieve suffering—touches sensitive nerves, exposing the fragility of our existence.

This topic draws a fine line between those who champion individual autonomy and those who fear it risks devaluing human life. In our society, productivity often shapes our ethics, influencing how we value lives. Is a life less worthy if it does not fit economic or social molds? This question makes me wonder if normalizing euthanasia could lead us to see existence as disposable, a concern echoed by Korean German philosopher Byung-Chul Han.^2,3

A Cultural Lens: Mexico’s Debate

In Mexico, where I live, the Catholic Church’s belief in the sanctity of life profoundly shapes the political landscape. Active euthanasia and assisted suicide are banned under the General Health Law (Article 166 Bis 21), which labels euthanasia as “mercy killing.” Yet, since 2008, Mexico City’s “Advance Directives Law” has allowed terminal patients to refuse life-prolonging treatments, a practice now adopted in over 19 Mexican states such as Aguascalientes and Michoacán.

This reflects a tension between autonomy and the Church’s caution against relativizing life. While 72% of Mexicans support euthanasia according to a survey (conducted by the Mexican association, “Por el Derecho a Morir con Dignidad,” For the Right to Die with Dignity, 2022), the Church’s influence and political hesitancy—especially during elections—stall reforms, leaving the debate unresolved.⁴ As Han critiques in The Palliative Society (2021), our “algophobia,” or fear of pain, drives a culture that seeks to eliminate suffering at all costs, raising questions about whether euthanasia stems from true autonomy or external pressures like economic burdens or stigma.³

A Psychiatric Perspective

Di Nicola, a child psychiatrist dedicated to saving suicidal youth, finds euthanasia incongruent with his mission. He states he would neither assist nor incite death, except by respecting do-not-resuscitate orders—a stance that resonates with me. How can we reconcile preventing suicide in some while promoting assisted suicide as a “right” for others, especially in cases of mental illness? Di Nicola highlights the moral ambiguity of distinguishing between suicides we must stop and those deemed “dignified deaths.” As a colleague responding to his article noted, euphemisms cloud this judgment, risking abuses when classifying someone as “eligible” for euthanasia.⁵

Even in countries like Belgium and Canada, where euthanasia is legal for mental illness, controversies arise over hasty decisions influenced by poverty or limited palliative care access. Di Nicola warns of a “slippery slope,” a concern I share when considering vulnerable populations.

Life’s Unpredictable Resilience

Yet life often defies our certainties. My business partner’s son, given no hope after a 3-year coma from COVID-related encephalitis, survived after life support was withdrawn—a decision distinct from euthanasia, as it allowed natural death. Today, he lives independently, a reminder that science is not always the final word. Similarly, my daughter-in-law’s brother, quadriplegic at 23 after a tragic accident, once seemed to have lost purpose. Now married, a Paralympic athlete, and an exceptional psychiatrist, his story testifies to the intrinsic value of life, even in seemingly unbearable circumstances.

A Call for Honest Dialogue

In euthanasia, I see a deep pain of our century: the tendency to relativize life under the logic of productivity and convenience, as Han’s algophobia suggests. It makes me wonder: are euthanasia decisions truly autonomous, or do they reflect pressures like care costs or the stigma of dependency? The line is blurry, and the risks—especially for the vulnerable—are real.

This debate, part of our collective consciousness for millennia, is terribly complex. It demands we confront the paradox of classifying euthanasia, suicide, and assisted suicide: one to prevent at all costs, another presented as a right. As a society, we need honest dialogue, free of euphemisms, with deep respect for life’s mystery. Because, as my partner’s son and my daughter-in-law’s brother show, life holds surprises, even when hope seems lost.

Final Reflection: “The Burnout Society” and the Fragility of Existence

Byung-Chul Han’s The Burnout Society (2015) warns of a world exhausted by relentless self-optimization, where life is reduced to performance metrics, and suffering is an anomaly to be eradicated.² This lens sharpens the concerns raised at the outset of this article, inspired by Di Nicola’s reflection on “the value of life, the morality of death, and the role of individual autonomy.”¹ In a society that equates worth with productivity, euthanasia risks becoming a symptom of our burnout—a surrender to the pressure to eliminate pain and dependency rather than embrace life’s unpredictable resilience.

The push for euthanasia may not always reflect true autonomy but rather a societal exhaustion with the messiness of existence. As we navigate this debate, we must ask: are we honoring individual choice, or are we, in our weariness, devaluing the mystery of life itself? True dialogue, grounded in respect for both suffering and survival, is our only path forward.

Claudia Goméz Robledo is a family therapist and community organizer in Mexico City, Mexico. She was born in Bogotá, Colombia and raised in Managua, Nicaragua. She has a Master’s in Systemic Therapy with a ⁠Specialization in Couples Therapy from the CRISOL Centro de Postgrado en Terapia Familiar y de Pareja (Postgraduate Centre for Family and Couple Therapy) in Mexico City and is the Executive Director of COLECTIVO 7 Mental Health, a therapeutic space dedicated to mental health with an integrative model, combining the expertise of various therapeutic tools.

References

1. Di Nicola V. Socrates’ choice: a philosophical perspective on euthanasia, suicide and assisted suicide. Psychiatric Times. April 28, 2025. https://www.psychiatrictimes.com/view/socrates-choice-a-philosophical-perspective-on-euthanasia-suicide-and-assisted-suicide

2. Han B-C. The Burnout Society. Stanford University Press; 2015.

3. Han B-C. The Palliative Society: Pain Today. Polity Press; 2021.

4. The 2022 DMD México survey. Por el Derecho a Morir con Dignidad A.C. (For the Right to Die with Dignity). Accessed May 28, 2025. https://dmd.org.mx

5. Pies RW. Solemnly renouncing physician-assisted suicide: a response to Vincenzo Di Nicola. Psychiatric Times. May 7, 2025. https://www.psychiatrictimes.com/view/solemnly-renouncing-physician-assisted-suicide-a-response-to-vincenzo-di-nicola