Suicide attempts and resuscitation dilemmas

Rational Suicide in Late Life: A Systematic Review of the Literature

“…Last, 6 papers were not specifically focused on late life rational suicide but mentioned it [21,28,39,40,43,49]; 3 included case(s) descriptions; all but one[40] specified the professionals involved in end of life issues. Four of these six studies [21,28,39,43] mentioned criteria for the definition of rational suicide: Motto’s [23]; Siegel’s [21] and Werth’s [41]; Werth & Cobia’s [22]; Hoche’s “Balance sheet suicide”[21].…”

“…All but one of these six papers [43] mentioned the Hemlock Society and either euthanasia, PAD, PAS, right to die; 2 [21,40] mentioned the Living Will.…”

“…It is not clear whether this last result reflects mistrust in the possibility of suicidal individual to receive help, or rather the general population’s actual belief that late life suicide is not a clinical issue. Mankind’s history has witnessed changing views about death and suicide, which in clinical contexts have both turned out to be something which should be always prevented, fought and avoided; this is linked to the topic of the principles of autonomy versus beneficence, and of patients’ autonomy and physicians’ responsibility [28,40]. Conflicts inevitably surround the approach to rational suicide also from this standpoint, starting from the ethical principle guiding healthcare professionals, who should respect patients’ autonomy as well as safeguarding their lives.…”

“…Even though Authors do not agree on the role of mental disorders in “rational suicide”, usually those who adhere to the conventional psychiatric opinion think that mental disorders are preeminent with regard to suicidal ideation and that suicide is a manifestation of psychiatric illness, hence they do not consider suicide as a rational option [40,54]. The possibility to disentangle depression and suicidal ideation in old-age suicidal individuals would allow the identification of potential targets for ad hoc interventions, going beyond those specifically directed towards the treatment of depression.…”

“…For instance, there might still be chances, even for terminally ill and/or disabled older adults, to find relief from their pain and suffering, which could eventually lead to a decrease in suicidal ideation and suicide risk [19]. Furthermore, the perspective considering suicide as a symptom of psychiatric illness overlooks the possibility that there may be circumstances in which suicide or the refusal of life-sustaining medical treatment may result from the rational decisions of autonomous individuals, and may lead to interventions aimed at preserving life which can sometimes be applied at the expense of individual autonomy[40].…”