Rational suicide reconsidered: Aids as an impetus for change

Abstract

At the present time, there does not appear to be an acceptable alternative to intervening to prevent the suicide of persons who display suicidal ideation. This absolutist and, at times, paternalistic view may change, however, as a result of professionals' contact with persons with AIDS. The growing number of persons with AIDS and the incidence of suicide within this population make it increasingly likely that individuals in a number of professions that subscribe to the policy of mandatory suicide intervention will have contact with a suicidal person with AIDS. Given the life circumstances and implications associated with a diagnosis of AIDS, there is the possibility that some of these suicidal persons with AIDS may have made what could be considered to be a rational decision to end their own lives. By taking into account the circumstances that precipitated the suicidal ideation and allowing some individuals to follow through with their plans, professionals will be empowering and returning autonomy to these individuals. Thus, by forcing professionals to think about and deal with the issue of rational suicide, AIDS may provide an impetus to change the traditional absolutist approach of suicide intervention and prevention into a contextual approach in which the intensity of suicide intervention required is viewed as varying along a continuum.

Rational suicide: uncertain moral ground

“…Why or why not?’ Eighty‐eight per cent of respondents indicated that they believed in the concept and described their beliefs about the term, which consisted of approving of the act when: (a) people contemplate suicide when there is an unyielding hopelessness in their condition according to their perception, (b) they are not coerced and they make a free choice about suicide and (c) they exercise sound decision‐making in the process. These beliefs were consistent with those described by Siegel (1986) and Werth (1995).…”

“…The defining characteristics of rational suicide suggested by Siegel (1986) include suicidal persons having a realistic assessment of their life circumstances, being free from psychological and severe emotional distress, and having a motivation that would be understandable to most uninvolved observers within the suicidal person's community. Two additional characteristics provided by Werth (1995) include decision‐making that has been deliberated over a period of time and involvement of the suicidal person's significant others when possible.…”

“…When stating positions about rational suicide, a first assumption is that it is a calculated suicide that is well planned by a person who is rational. With this thought‐out plan being assumed as rational, a position of acceptance towards rational suicide has been proposed as a reasonable and ethical one for health care professionals when considering the autonomous wishes of those who meet certain criteria proposed by Siegel (1986) and Werth (1995). Essential to these criteria are that:…”

Social Work Assessment at End of Life

“…In Werth's (1995) article on rational suicide and AIDS, a suicide intervention continuum which ranges from low to high acceptance and much to little preventive action is examined. The author believes that the "conditions that cause suicidal ideation to arise should be taken into account when one is deciding on the amount of intervention that is necessary and appropriate" @.…”

“…Most of the clinical literature stems from the medical field (Quill, Cassel & Meier, 1992;Quill, 1993b;Jecker, 1991), and there is little or nothing to guide social workers Downloaded by [New York University] who work with the terminally ill and have responsibility for their plans of care. There is some growing recognition of suicide in persons with AIDS (Beckerman, 1995;Werth, 1995).…”