So this isn't meant at all to provide an analogy, as it's a different circumstance. But I'm curious about your personal opinion. Someone has curable cancer (but definitively imminently fatal), but they irrationally reject treatment saying "the stars aren't aligned properly for it" or some nonsense like that. OK to tie them down and cut out the cancer? I'm always curious where people draw the line for when force is ok to use to make someone do the 'better' or more life-giving thing.
It would be odd indeed if it was OK to stop the dying only if they intentionally performed the action that led to their (imminent) death, but not OK to stop the dying if it was caused by something like a disease.
On the surface that seems like a solid argument - but I think there are some key differences when comparing a situation where a cancer patient refuses surgery and somebody with mental illness refuses help getting their lives in shape.
For a start surgery is clearly a much more invasive and risky operation, and even if successful at removing the cancer, can leave the patient in a physically weakened/dependent state for some period of time. It also clearly requires highly-trained specialists to perform the operation and can only be done in controlled environs (operating theatre etc.). If there were any suggestion this were true for providing assistance for the severely mentally ill, then I'd be more inclined to agree with you that there's no good justification for imposing such treatment without their express consent. As it is, I certainly agree that there needs to be a strong system of checks and balances for any such scenario, including time-limits over how long it's legal to hold somebody against their will.
As it is, we don't let dementia patients simply do whatever they like even if they initially consented to entering a care facility, but then no longer want to stay there (which is not uncommon). Whether it's a duty-of-care argument, or simply that doing so would result in too much risk to others, at some point we have to accept even grown adults are no longer capable of rational/informed consent, and we do actually have doctors trained in making such diagnoses.
I think the gulf between opinions here is I see adulthood (and fundamentals like ability to do as you please to your own body) as irrevocable until at least a crime against a (not yourself) victim has been performed. Ideally I would live in a society where people have agreed to such, in practice I've just tried to move to places where the least number of people such as my counterparty above exist so as to reduce my exposure to such impositions of violence. In practice I've ended up in fairly rural western states where individualism is highly preserved, you can do things like buy weed without a card or carry a gun without a license and hell even be senile/demented/schizophrenic at the same time as both and as long as you don't fuck with anyone else people tend to not impose anything on you -- notwithstanding no such place perfectly does this and you'll no doubt find horrible counterexamples where this didn't play out.
I do not think the alternative society that say maximizes certain utilities at the cost of consent is wrong per se as long as it's possible to freely enter/exit such a society, I just find it incompatible with my values. While I disagree with the notion of stopping someone who has asked his/her respects to be honored in regard to suicide, I don't think it's some moral failing if a private individual makes an in-the-moment reaction to stop them. It's pretty much human instinct to try to preserve innocent life of those around us, so hopefully it hasn't been read that I think you're a bad person or something if you see someone cutting themselves and you stop them.
No. Refusing treatment for some cancers might be a sign of mental illness, though not definitive proof. Testicular cancer, for example, is highly amenable to treatment. Whereas pancreatic cancer is not. Refusing treatment for pancreatic cancer is entirely rational - the chances of a cure are almost nil unless it's caught incidentally during another procedure and can be surgically removed.
Do you completely refuse to accept that there is such a phenomenon as mental illness? If you are of a sound mind and want to starve to death - have it your way. If you are a schizophrenic lying face down on the street - there is something we can do to help you. It's possible with the help of modern medicine to give you a decent life, restore your function.
What is this theoretical individual losing if we help them? What is the society losing if we act to help?
The dictator part in me, if given the ability, would wave a magic wand and make these individuals 100% neurotypical for 24 hours. At the end of the time, I would ask them if they want to (1) wave the wand again and stay this way as long as they like (2) Go back to their <diagnosed disease> self or (3) commit suicide. I don't know what the answer would be, but I imagine the vast majority would pick (1), a few would pick (2) and a few would pick (3). From that point on, I would defer their suicide decisions to themselves.
Sadly that is not the reality we live in. The dictator, in this case is New York and various government entities. A government notorious for putting mentally ill in wards where people are "living in filth and dirt, their clothing in rags, in rooms less comfortable and cheerful than the cages in which we put animals in a zoo." [0] Without magic wands, the doctors are not always returning them to neurotypical condition, but rather often some other, perhaps clinically more palatable often drug-induced different mental state. There is often no neurotypical state the wand can be waved to, and often the decision for suicide overlaps between "ill" ad not ill persons particularly when they're subjected to indefinite stays in facilities under conditions of sexual abuse such as historically found in New York mental wards. Hell I might argue it may be cruel to stop someone from committing suicide to avoid being "helped" by New York.
That is, we are dealing with gritty, dirty reality where the mentally ill entity that is the state of New York, itself unqualified in its mental facilities, has a history of sexually and physically abusing people [0, but that's not all] to "protect" them from their own mental illness/suicide etc. Even if the consent argument fails on merits (I disagree), I argue the decision cannot and should not rest on the state in non-criminal concerns of imposing force on the ill (and notwithstanding the dystopic notion of government entities choosing who meets often poorly defined mental diseases).
With the state totally unqualified, and the individual on his own on the street often with family far removed, I defer to his perhaps ill consent. Notwithstanding, of course all help that can be offered should be.
It would be odd indeed if it was OK to stop the dying only if they intentionally performed the action that led to their (imminent) death, but not OK to stop the dying if it was caused by something like a disease.