Musings of a phenomenologist

Science, psychiatry and random musings

Archive for September, 2009

Suicide isn’t painless

Posted by soveda on September 4, 2009

Sorry for the punning title, I know Painless was the name of the dentist in M.A.S.H. but I couldn’t resist.
I was just pondering suicide and euthanasia, this was triggered by world suicide prevention day and the lack of coverage in the media.

Now suicide is a bad thing isn’t it?

It’s one of the targets the UK government has for mental health services – to reduce the rate of suicide and undetermined injury by 20% by 2010 (document here)

There are guidelines about reporting suicide (see here), and for good reason. When the media in Hong Kong reported a suicide by a novel and previously unknown method that method increased rapidly (see here).

Suicide is a symptom of mental disorder – however some people who complete suicide have no history of mental disorder.

The national confidential inquiry into suicide and homicide makes for interesting reading (link) The press release states:

The number of people killed by individuals suffering from mental illness in England and Wales increased between 1997 and 2005, figures released today show.  The rise occurred in people who were not under mental health care and was not found in mental health patients.

The annual report by the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness also found:

  • a fall in suicide by mental health patients overall and a continued fall in suicide by in-patients
  • suicide following absconding from the ward remains a serious problem
  • however, few serious incidents occurred following absconding from secure units

Of note “patient” means: having had contact with mental health services in the last 12 months.

So it’s clear cut …

Is it possible to wish to end your life without suffering from a mental illness? Now there’s a thorny question, if you asked most psychiatrists I suspect they would tell you that thoughts of suicide and a wish to die were not in and of themselves a sign that someone was mentally ill. Someone would likely be in some degree of distress, either mental or physical, but not necessarily mentally ill. Bit how about those individuals who wish to end their lives on their terms rather than letting a terminal illness make the decision for them (please forgive the anthropomorphising of a process), are they mentally ill?

Some would argue that they are by definition because they wish to end their lives, even if it is a rational decision.

Is that paternalism or realism?

By condoning suicide in those cases are we encouraging people to look at suicide rather than other options in managing disease. especially if you start including mental illness in the diagnoses that are “allowable” in assisted suicide. (BJPsych editorial)

Given that there is to be new guidance on assisted suicide this question will not go away. (BBC report)

For what it’s worth, physician assisted suicide/euthanasia does not sit well with me ethically. I want people to have a god quality of life and I don’t want people to feel pressurised into ending their life because they are a burden. Given the probable high numbers of people who have undiagnosed cognitive impairment/dementia who are vulnerable to this very thought process I think PAS is too risky a proposition.

Now that was the most unfocussed and self contradictory I’ve been in a while but hey, I’m human too.


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