Suicide: Rationality and Responsibility for Life

Abstract

Objectives: Death by suicide is widely held as an undesirable outcome. Most Western countries place emphasis on patient autonomy, a concept of controversy in relation to suicide. This paper explores the tensions between patients' rights and many societies' overarching desire to prevent suicide, while clarifying the relations between mental disorders, mental capacity, and rational suicide.Methods: A literature search was conducted using search terms of suicide and ethics in the PubMed and LexisNexis Academic databases. Article titles and abstracts were reviewed and deemed relevant if the paper addressed topics of rational suicide, patient autonomy or rights, or responsibility for life. Further articles were found from reference lists and by suggestion from preliminary reviewers of this paper.Results: Suicidal behaviour in a person cannot be reliably predicted, yet various associations and organizations have developed standards of care for managing patients exhibiting suicidal behaviour. The responsibility for preventing suicide tends to be placed on the treating clinician. In cases where a person is capable of making treatment decisionsuninfluenced by any mental disorder-there is growing interest in the concept of rational suicide. Conclusions:There is much debate about whether suicide can ever be rational. Designating suicide as an undesirable event that should never occur raises the debate of who is responsible for one's life and runs the risk of erroneously attributing blame for suicide. While upholding patient rights of autonomy in psychiatric care is laudable, cases of suicidality warrant a delicate consideration of clinical judgment, duty of care, and legal obligations. W W W Suicide : rationalité et responsabilité de la vieObjectifs : La mort par suicide est généralement vue comme un résultat indésirable. La plupart des pays occidentaux mettent l'emphase sur l'autonomie du patient, un concept controversé relativement au suicide. Cet article explore les tensions entre les droits des patients et le désir ardent de nombreuses sociétés de prévenir le suicide, tout en clarifiant les relations entre les troubles mentaux, la capacité mentale, et le suicide rationnel.Méthodes : Une recherche de la littérature a été menée à l'aide des mots clés suicide et éthique, dans les bases de données PubMed et LexisNexis Academic. Les titres et résumés d'articles ont été étudiés et jugés pertinents si l'article abordait les sujets du suicide rationnel, de l'autonomie ou des droits des patients, ou de la responsabilité de la vie. D'autres articles ont été repérés dans des bibliographies et par des suggestions des réviseurs préliminaires du présent article. Résultats :Le comportement suicidaire d'une personne ne peut pas être assurément prédit et pourtant, diverses associations et organisations ont mis au point des normes de soins pour prendre en charge les patients présentant un comportement suicidaire. La responsabilité de prévenir le suicide tend à être imposée au clinicien traitant. Dans les cas où une personne est capable ...

Consideraciones acerca de la conducta suicida de pacientes hospitalizados y responsabilidad del médico tratante

“…De hecho, entre 20% y 51% de quienes trabajan en salud mental enfrentarían la muerte de uno o más de sus pacientes por esta vía 33,34 , con el consiguiente efecto psicológico entre estos. Aunque el suicidio es una conducta humana compleja, su frecuente asociación con patología psiquiátrica y la medicalización de este lo ha convertido en un fenómeno íntimamente asociado a la práctica médica, en particular a la práctica psiquiátrica.…”

“…Aunque en los casos de psicosis o de alteración transitoria de la capacidad de ejercer el mejor juicio, la autoagresión puede ser considerada producto de su condición psicopatológica, en la mayoría de los casos de suicidio en hospitalizados esto ha ocurrido en individuos con circunstancias psicopatológicas que no disminuyen los derechos y autonomía del paciente, lo que ha llevado incluso a algunos autores a plantear el concepto del "suicidio racional" 33 , esto es equiparar algunos casos de decisión suicida a lo observado en casos como enfermos terminales sin enfermedad psiquiátrica. Aunque estas propuestas son controversiales, ponen de manifiesto la necesidad de mantener el foco de la responsabilidad por la conducta suicida en el sujeto que la ejecuta, transferirla al médico transformaría el cuidado de personas con trastornos mentales en un acto temerario e incentivaría a que los equipos no se hagan cargo, justamente de acoger y tratar a sujetos con gran necesidad de ayuda.…”

When Is Depression a Terminal Illness? Deliberative Suicide in Chronic Mental Illness

“…Historically, this stance has support; there are and have been social and legal proscriptions against the act of suicide [1]. Similarly, psychiatrists could face malpractice lawsuits involving the suicide of a patient that is deemed to be caused by professional negligence [11].…”

“…In Oregon, for example, the Death with Dignity Act [12] expresses legal acceptance that terminally ill patients should have recourse to hasten death given the potential for suffering. Similarly, unendurable psychological suffering could be a legitimate reason for stopping treatment and hastening death by suicide [11]. Without delving into the meaning of unendurable psychological suffering, we might consider that a lifetime of refractory mental illness might be unendurable and can-and, for many, does-result in a shortened life span [11].…”

“…Similarly, unendurable psychological suffering could be a legitimate reason for stopping treatment and hastening death by suicide [11]. Without delving into the meaning of unendurable psychological suffering, we might consider that a lifetime of refractory mental illness might be unendurable and can-and, for many, does-result in a shortened life span [11]. The illness, in fact, proves terminal, be it from disease, accident, or intent.…”