Summary. This article analyzes the dichotomy between suicide and assisted death from a psychological and bioethical perspective, questioning the sovereignty of the individual over their own existence. Through the lens of health psychology and drawing on literary reference points such as Tolstoy and legal frameworks such as Organic Law 3/2021 in Spain, it explores how institutions (State, religion and society) exercise control over the body and the life of the person from birth. Regulated euthanasia is not a renunciation of life, but the recovery of autonomy in the face of a system that often dispossesses the individual of their capacity to decide about their own end.
Introduction: the expropriated body
No one asks to come into the world. Yet, from the moment of birth, the human being enters a framework of roles, labels and institutional controls. Biological sex is wrapped in an already marked gender identity, culture imposes what is right or wrong, and religion dictates the sacredness of a life the individual did not choose to have. In this scenario, life is managed as an asset of the State or a gift from the deity, taking away from the person the command over it and turning them into a mere tenant of their own existence.
As a health psychologist devoted to addressing suicidal behavior, I observe every day how external surveillance collides with the deepest human suffering: the kind that leaves no trace on an X-ray. While society accepts the finitude of a body facing cancer, it is reluctant to validate the end of a life broken by treatment-resistant psychological suffering. This article does not seek to promote death, but to bring into discussion the possibility of a dignified passing under the protection of the law, distinguishing the solitary violence of suicide from the deliberate peace of assisted death.
1. Necessary definitions: from chaos to a clinical process
For the debate to be honest, we must distinguish the concepts. Suicide (non-assisted) is a self-inflicted act carried out in isolation, often associated with acute crises without supervision. By contrast, euthanasia and assisted suicide (EAS) are highly regulated clinical and legal processes.
According to the Ministry of Health (2021), euthanasia in Spain requires four pillars: voluntariness, medical intervention, irreversibility of the condition and unacceptable suffering. Countries with advanced legislation, such as the Netherlands, show that this is not a private act, but a system with subsequent oversight by regional committees (RTE), mandatory second opinions (the SCEN program) and public transparency (Kim et al., 2016).
2. The mirror of literature: Ivan Ilyich and invisible suffering
Leo Tolstoy, in The Death of Ivan Ilyich, gave us the perfect portrait of human agony. Ivan understood that his tragedy was not only physical, but the result of a life of lies and the loneliness of dying surrounded by people who refuse to acknowledge his suffering.
In the work, the character of Gerasim acts as the forerunner of modern palliative care. His compassion is born of the recognition of a shared vulnerability. Today, the debate seeks to recover that gaze of Gerasim: a transition from death understood as a solitary biological failure toward a human process that requires truth and relief.
However, Ivan Ilyich poses an uncomfortable question to us: what happens when the blow leaves no physical mark, but a mark on the psyche? Unlike Ivan, whose deterioration is biologically evident, the person ill with psychological suffering faces a pain without biological markers. To deny the finitude of mental suffering under the pretext of its invisibility is to push the individual toward the violence of solitary suicide.
3. The Spanish legal vanguard and the challenge of mental health
Organic Law 3/2021 (LORE) in Spain marked a change of paradigm by not establishing a hierarchy between the pain of the body and that of the spirit. The rule allows aid in dying in the face of constant and intolerable physical or psychological suffering, validating the patient's self-determination even in refractory mental disorders.
This is vital in order to transform a violent death into an assisted medical act. While suicide is often a symptom of an untreated crisis, EAS in Spain requires a clinical assessment that certifies a firm and sustained will, ensuring that no one dies because of a passing episode (Cabrera Leon, 2021).
4. Criticisms and risks: vital weariness
We cannot ignore the ethical reservations. The Bioethics Committee of Spain (2020) warns that the right to die must not eclipse the State's duty to protect the vulnerable, preventing euthanasia from becoming a quick solution in the face of a lack of palliative care or social support.
Here arises the concept of vital weariness (Paramo, 2023). By opening the door to invisible forms of suffering, we run the risk of the slippery slope: medicalizing existential crises, grief and the sufferings of daily life, or assuming that human pain is unsolvable. It is the most complex point of our profession: to distinguish between the wish to die as a symptom and the wish to die as a dignified biographical conclusion.
Conclusion: the final right
The modern understanding of a dignified death has evolved toward the protection of autonomy (Castro and Rego, 2022). At the end of the road, Ivan Ilyich and Ramon Sampedro meet: both men trapped in environments that refused to listen to their truth.
Giving the human being back the right to decide about their own end is not a betrayal of life, but the greatest act of respect that the State and society can offer. It is the transition from traumatic suicide to the freedom to choose your own destiny, reclaiming, at last, the ownership of our body.
If you are going through a moment of suffering or have thoughts of suicide, you are not alone and asking for help is an act of courage. In Spain you can call, free of charge and confidentially, 024, the suicidal behavior helpline, available 24 hours a day. You can also turn to your psychologist or your regular doctor.
