Rational suicide: philosophical perspectives on schizophrenia

Abstract

Suicide prevention is a National Health Service priority in the United Kingdom. People with mental illness are seen to represent one of the most vulnerable groups for suicide and recent British Government policy has focused on prevention and management of perceived risk. This approach to suicide prevention is constructed under a biomedical model of psychiatry, which maintains that suicidal persons suffer from some form of disease or irrational drive towards self-destruction. Many react to the idea of self-inflicted death with instinctive revulsion, which has prevented serious discussion of the concept of rational suicide, particularly in relation to those with schizophrenia. The idea that there may be circumstances in which suicide can be viewed as rational is discussed within the biomedical approach to ethics and wider literature primarily in relation to physical disease, terminal states and chronic pain. It is not deemed a viable choice for those who are considered 'non-autonomous' due to the controlling forces of mental illness. I propose that suicide is not a consequence of mental illness per se, and that it may be seen as a rational response to a realistic perspective on the course and consequences of living with schizophrenia. The denial of dialogue about the validity of suicidal ideation for people with schizophrenia has led to negative consequences for people with serious mental illness in terms of justice and recognition of person-hood.

Subjective quality of life and suicidal behavior among Taiwanese schizophrenia patients

“…This finding is consistent with that of Ponizovsky et al [21] and suggests that the SQOL measure we used can tap the quality of social relationships as a crucial element in suicidal behavior. Quality of life studies show that subjective satisfaction is related to social functioning and not severity of psychotic phenomena [5,53]. People with schizophrenia have been shown to be better able to evaluate the quality of their lives [5,53] and are therefore capable of second-order desires, reflectively examining the experience of living with serious mental illness [5].Important factors for a satisfactory QOL for people with schizophrenia include social networks and family support [54].…”

“…Quality of life studies show that subjective satisfaction is related to social functioning and not severity of psychotic phenomena [5,53]. People with schizophrenia have been shown to be better able to evaluate the quality of their lives [5,53] and are therefore capable of second-order desires, reflectively examining the experience of living with serious mental illness [5].Important factors for a satisfactory QOL for people with schizophrenia include social networks and family support [54]. As noted, social isolation, loneliness, and inadequate social support are common traits of both patients with schizophrenia and suicidal subjects [21].…”

“…The high risk of suicide persists throughout the life span of schizophrenia patients [1]. The plethora of health policy documents make clear links between a diagnosis of schizophrenia and suicide, with two key assumptions: (1) a diagnosis of schizophrenia carries a higher risk of suicide and (2) suicide for people with schizophrenia occur as a direct result of psychotic phenomena [5]. Elucidating the characteristics of schizophrenia patients who have suicidal ideations or make suicide attempts is of great importance for determining who is most at risk and thus should receive intensive treatment to minimize the possibility of suicide.…”

The Supreme Court of Canada Ruling on Physician-Assisted Death: Implications for Psychiatry in Canada

“…39 In psychiatry, suicide has traditionally been viewed as a direct result of psychopathology, not the result of deliberate reasoning and decision making. 40,41 The notion of rational suicide is not new, but the Supreme Court ruling challenges Canadian psychiatrists to become actively involved in the international debate. There is a growing body of literature that addresses the question of whether or not suicide can be a rational decision even in patients with mental illness.…”

“…There is a growing body of literature that addresses the question of whether or not suicide can be a rational decision even in patients with mental illness. 42, 43 Hewitt 40,41 argues that hopelessness and the desire to die are not necessarily a direct result of mental illness but could be reasonable responses to life circumstances, and suicidality can be rational even in patients with mental illness. In the context of the Supreme Court's rulings, will psychiatrists be asked to dichotomize an existing demographic of patients with mental illness who are suicidal into rational and irrational groups?…”