Psychiatrists and Suicide Prevention - Essay Example

Psychiatrists and suicide Prevention Introduction: From a legal perspective, the term suicide is defined as “an act of malicious self-murder, felo de se”(www.lectlaw.com) and is the practice whereby a person chooses to end his or her life. Burgess and Hawton (1998) have pointed out that while suicide has been a part of the history of mankind, the attitude of society towards it has changed over time. Suicide is a commonly occurring event in classical literature and was viewed as a noble, heroic act that was engaged in to avoid dishonor. However, during the medieval age, Christian beliefs held suicide to be a sin instigated by the devil and therefore equivalent to a crime deserving severe punishment. Hindu culture has rendered certain forms of suicide acceptable, such as for example, the practice of Sati or immolation of a woman on her husband’s funeral pyre, while the Japanese custom of Hara-kari promotes suicide over dishonor. According to David Hume, suicide is an acceptable alternative - "if it be no crime, both prudence and courage should engage us to rid ourselves at once of existence, when it becomes a burthen.” (Hume, 1784:19) But as Burgess and Hawton (1998) have clarified, the modern day view of suicide is the concept of suicide as a mental health problem. Suicide ceased to be viewed as a criminal problem and the position changed to one where “the contemporary physician sees suicide as a manifestation of emotional illness. Rarely does he see it in any context other than that of psychiatry.” (JAMA: 1967:162). According to Marjorie Wallace, the chief executive of mental health charity SANE, “one in ten people with severe depression may take their own life.” (Connor, 2007). Ever since suicide has begun to be viewed as a mental health problem, mental health practitioners have been imbued with the professional duty to prevent it, so that when an individual who is a patient under the care of a mental health practitioner commits suicide, the latter can be sued and found guilty of professional negligence.(Szasz, 1986). However, the question that arises in this context is – should a mental health practitioner be held to be responsible for failing to prevent suicide or is suicide an act whose responsibility must be solely placed at the door of the person who commits it? Analysis: Physician assisted suicide must be differentiated from euthanasia, where it is the medical practitioner himself/herself who makes the decision to end the patient’s life in order to end their suffering, especially in cases where the patient is terminally ill or in a coma and is not capable of communicating a wish to die and end suffering. While physician assisted suicide is carried out specifically on the request of the patient and therefore involves the autonomy of the patient, in the case of euthanasia, it is the doctor who makes the decision, sometimes on the basis of requests from family members of the patient, and removes the patient from life support systems. Weir(1997:137) has summed up the arguments that are in favor of physicians providing assistance to patients in achieving their own suicides. Some of these arguments are as follows: (a) Physicians have a moral obligation to relieve the suffering of their patients. They generally accomplish this through use of medication and treatment. However, in those instances where medication and treatment that prolongs life will be inconsistent with the provision of relief, physicians may be able to better relieve their patients’ suffering by shortening the life span of enduring of the suffering. (b) In some cases, patients prefer physician assisted suicide to living on with their disabling condition. In such instances, a physician has a moral obligation to respect the autonomous choice and decision of his/her patient to end their lives (c) Legalizing physician assisted suicide would ensure that appropriate safeguards are also instituted, so that there is no abuse of the facility of physician assisted suicide. (d) A total refusal to consider physician assisted suicide is in fact a disservice to a patient and equivalent to abandonment of the patient, since most patients who are terminally ill may experience unbearable suffering and autonomously request physician assisted suicide. (e) Physician assisted suicide is a wholly personal and private act and strictly between the patient and his/her physician. On this basis therefore, it may be noted that the primary arguments in favor of physician assisted suicide are centered upon the individual autonomy of a patient to make his or her own decision about whether or not to continue living. For patients who are terminally ill and suffering a great deal, relief from suffering through death is their only hope, since they do not wish to continue to be dependent on others and continue to suffer. As a result, the more merciful option from a moral perspective, appears to be to allow the patients to die through physician assisted suicide (Weir, 1997). However, the converse argument is that the long standing prohibition of physician assisted suicide rests upon the solid moral, medical and religious principle that it is dangerous and wrong to allow suicide as a means of ending suffering and even more so, to make physicians the agents through whom such a wrong action is implemented. From the moral perspective, choosing death may be wrong because life is a gift from God, from a philosophical perspective, death is the ultimate absurdity, because it is a rejection of the freedom we as human beings have to bring meaning into our own lives (Matthews, 1998). Voluntarily choosing death, unless extenuating circumstances exist, would therefore be morally and ethically wrong. While it may be valid in individual cases, applying the right to take one’s own life on an ad hoc basis across society would be an untenable proposition. On this basis, physicians do have a duty to prevent suicide, in order to prevent it becoming a principle that is accepted by society as a whole. Suicide is a form of desperation, usually the result of some form of depression that can be treated, therefore it cannot be legitimized and socially endorsed as a wide ranging practice.(Weir 1997). If physicians begin to assist patients in suicide, then such incidents will become prevalent in society. While suicide may be excusable in the case of a few, sporadic individuals, it cannot be condoned as a practice widely accepted by society. Unless physicians resist and prevent suicide, it will indeed become a wide ranging practice, which is an unacceptable moral position. Allowing physicians to assist in suicide is equivalent to placing the power over another person’s life into a physician’s hands and providing him or her with the right to kill another, albeit at the express wish of the other. Such power would be unacceptable merely for the purpose of providing the right to take life as a means of eliminating despair. However, while a physician should not be allowed to assist in suicide, this does not by association imply that they should be held responsible when a patient in their care commits suicide. Szasz (1998) argues that suicide is an act of a moral agent for which ultimate responsibility rests with that agent himself/herself rather than with the physician. It is a matter of moral complexity where life is precious on the one hand, while disability or disease may render a person’s life not worth living and make suicide a blessing. Since it is entirely a matter of individual choice in making such a complex moral decision, prevention through coercive sanctions by the State are based upon a faulty belief that it is the legitimate function of the State to coerce persons into living. Szasz (1998) argues that such coercive prevention is inappropriate in an area of complex morality such as death, and responsibility for such an act cannot be placed at the physician’s door; rather it is the sole responsibility and choice of the person engaging in the act. The reality that exists, however, is that physicians are held responsible for the welfare of their patients. The principle of autonomy requires that a person’s free will choice to end his or her life should be respected, however it is only those decisions that are the products of a sound, adult mind that can be considered to be valid decisions.(Burgess and Hawton., 1998). In the case of a patient who is terminally ill and connected to life support systems, or in the case of a mentally disabled patient, it is the physician who must assume responsibility for the patient’s welfare, as a result the physician is also held responsible if the patient of unsound mind commits suicide while in the physician’s care. As Lavin (1995) argues, patients who suffer from mental problems and are not competent to make decisions about their treatment or hospitalization should be committed, so that doctors can identify whether there is room for treatment and administer it appropriately. The basic assumption made in the case of these patients is that they are not competent to make their own decisions, therefore Szasz’s argument that suicide is purely an individual moral decision may not hold good in such cases. When individuals are mentally incompetent to make a decision about their own lives, then it is the physician’s duty to ensure that the life of the patient is preserved as far as possible, so that treatment can be administered to the fullest extent possible. The physician, unlike the patient himself, will not have the moral authority to take the patient’s life by assisting in suicide, because in instances of mental disability, the patient may not be competent to make a decision about suicide, and the physician cannot make the decision on his or her behalf. As pointed out by Burgess and Lawton (1998), a person with a mental illness is not of sound mind. Moreover, suicidal ideas may in and of itself be accepted as evidence of mental illness. The rationality of decisions to end life must also be raised and as Matthews (1998) points out, a person who is deluded into taking his or her own life on the belief that he or she is incapable of doing anything worthwhile, is suffering from a pathological disorder and the suicide decision cannot be an acceptable one. Since the mentally ill are always considered to be incompetent, and suicidal ideas provide evidence of mental illness, then by association, suicidal ideas and wishes are always incompetent and by extension, not logical or rational. As a result, there will be an ethical duty imposed upon psychiatrists and medical practitioners to prevent suicide wherever possible. (Burgess and Hawton, 1998). Conclusions: On the basis of the above, it may be concluded that in general physicians do have a duty to prevent suicide. It would not be a tenable proposition to apply the right to take one’s own life to society as a whole, including people who may not be mentally competent to make a decision about their own lives. The duty of a physician is to preserve life and to assist through alleviation of suffering and preservation of life, in as much as it is possible to do so. However, there may be individual instances where the patient is suffering so much that ending life provides the only means of relief from the incessant suffering. Moreover, in such cases, the question of autonomy of the patient to make his or her own decision about living must also be taken into account. In such instances, where the patient’s decision is clear, there may be justification for the physician to eschew the general principle to preserve life. However, where euthanasia is concerned, the moral complexity of the dilemma increases. A physician would be taking the life of another without a definite indication that the patient autonomously desires death, because the patient’s desires cannot be ascertained, either due to mental incompetence or because the patient is in a coma. In such an instance, a physician would be according too much power to himself/herself and taking a life that God has given and over which he/she has no right. It is only when the patient’s autonomous decision can be ascertained and ensured that a physician would be justified in assisting with a suicide. Where mentally incompetent people are concerned, the desire to commit suicide must itself be viewed with suspicion because a mentally incompetent person cannot make a sound decision about an issue as important as suicide. Moreover, since most of the suicide wishes are expressions of depression, a physician must also consider treating the depression rather than agreeing to the patient’s wishes as a blanket principle. References: * Burgess, Sally and Hawton, Keith, 1998. “Suicide, euthanasia and the Psychiatrist”, Philosophy, Psychiatry and Psychology, 5.2: 113-126 * Connor, Steve, 2007. “Tougher definition for depression poses suicide risk” The Independent on Sunday, 18 August, 2007. Retrieved November 16, 2007 from: http://news.independent.co.uk/health/article2874120.ece * Hume, D. 1784 (1986). “Of suicide.” IN “Applied ethics”, ed. P. Singer, Oxford: Oxford University Press, at pp 19-27. * Journal of the American Medical Association, 1967. “Changing concepts of suicide”, 199(10): 162; cited in Burgess and Hawton, 1998. * Lavin, Michael, 1995. “Who should be committable?” Philosophy, Psychiatry and Psychology, 2(1): 35-45 * Matthews, Eric, 1998. “Choosing death: Philosophical observations on suicide and euthanasia”, Philosophy, Psychiatry and Psychology, 5(2): 107-111 * Szasz, T, 1986. “The case against suicide prevention,” American Psychologist, 41:806-812. * “Suicide.” Retrieved November 16, 2007 from: http://www.lectlaw.com/def2/s197.htm * Weir, Robert F, 1997. “Physician assisted suicide”, Indiana University Press Read More