Patients with serious illnesses or injuries may decide to quit their medical treatment if they think paying the fees will put their families into destitution. Without treatment, it is likely that fatal outcomes will soon follow. We call this phenomenon “near-suicide”. This study attempted to explore this phenomenon by examining how the seriousness of the patient’s illness or injury and the subjective evaluation of the patient’s and family’s financial situation after paying treatment fees affect the final decision on the (...) treatment process. Bayesian Mindsponge Framework (BMF) analytics were employed to analyze a dataset of 1042 Vietnamese patients. We found that the more serious the illnesses or injuries of patients were, the more likely they were to choose to quit treatment if they perceived that paying the treatment fees heavily affected their families’ financial status. Particularly, only one in four patients with the most serious health issues who thought that continuing the treatment would push themselves and their families into destitution would decide to continue the treatment. Considering the information-filtering mechanism using subjective cost–benefit judgments, these patients likely chose the financial well-being and future of their family members over their individual suffering and inevitable death. Our study also demonstrates that mindsponge-based reasoning and BMF analytics can be effective in designing and processing health data for studying extreme psychosocial phenomena. Moreover, we suggest that policymakers implement and adjust their policies (e.g., health insurance) following scientific evidence to mitigate patients’ likelihood of making “near-suicide” decisions and improve social equality in the healthcare system. (shrink)

Suicide is a controversial ethical issue in large part because the reasonings of and above appear plausible but support contradictory conclusions. in effect asks: Why should we be granted an exemption to the prohibition on human killing when the person we kill is ourselves? What makes killing oneself so special? on the other hand starts from the intuition that there is something special or distinctive about the moral relationship we stand in to ourselves, a relationship that can at least (...) sometimes morally justify suicide. The reasoning of and thus establishes the contours of the ethical debate concerning the permissibility of suicide and explains why suicide is one of the most hotly debated issues in bioethics. (shrink)

_Suicide_ was selected as a Choice _Outstanding Academic Title_ for 2012! _Suicide: The Philosophical Dimensions_ is a provocative and comprehensive investigation of the main philosophical issues surrounding suicide. Readers will encounter seminal arguments concerning the nature of suicide and its moral permissibility, the duty to die, the rationality of suicide, and the ethics of suicide intervention. Intended both for students and for seasoned scholars, this book sheds much-needed philosophical light on one of the most puzzling and (...) enigmatic human behaviors. (shrink)

Objective: To explore the relationship between the presentation of suffering and support for euthanasia in the British news media.Method: Data was retrieved by searching the British newspaper database LexisNexis from 1996 to 2000. Twenty-nine articles covering three cases of family assisted suicide were found. Presentations of suffering were analysed employing Heidegger’s distinction between technological ordering and poetic revealing.Findings: With few exceptions, the press constructed the complex terrain of FAS as an orderly or orderable performance. This was enabled by containing (...) the contradictions of FAS through a number of journalistic strategies: treating degenerative dying as an aberrant condition, smoothing over botched attempts, locating the object of ethical evaluation in persons, not contexts, abbreviating the decision making process, constructing community consensus and marginalising opposing views.Conclusion: The findings of this study support the view that news reporting of FAS is not neutral or inconsequential. In particular, those reports presenting FAS as an orderly, rational performance were biased in favor of technical solutions by way of the legalisation of euthanasia and/or the involvement of medical professionals. In contrast, while news reports sensitive to contradiction did not necessarily oppose euthanasia, they were less inclined to overtly support technical solutions, recognising the importance of a trial to address the complexity of FAS. (shrink)

The standard of care in the United States favors stabilizing any adult who arrives in an emergency department after a failed suicide attempt, even if he appears decisionally capacitated and refuses life-sustaining treatment. I challenge this ubiquitous practice. Emergency clinicians generally have a moral obligation to err on the side of stabilizing even suicide attempters who refuse such interventions. This obligation reflects the fact that it is typically infeasible to determine these patients’ level of decisional capacitation—among other relevant (...) information—in this unique setting. Nevertheless, I argue, stabilizing suicide attempters over their objection sometimes violates a basic yet insufficiently appreciated right of theirs—the right against bodily invasion. In such cases, it is at least prima facie wrong to stabilize a patient who wants to die even if they lack a contrary advance directive or medical order and suffer from no terminal physical illness. (shrink)

Human suicide presents a fundamental problem for the scientific analysis of behavior. This problem has been neither appreciated nor confronted by research and theory. Almost all other behavior exhibited by humans and nonhumans can be viewed as supporting the behaving organism's biological fitness and advancing the welfare of its genes. Yet suicide acts against these ends, and does so more directly and unequivocally than any other form of maladaptive behavior. Four heuristic models are presented here to account for (...) suicide in an evolutionary and sociobiological framework. The first model attributes suicide to the extraordinary development of learning and cultural evolution in the human species. Learning may make human behavior so independent of biological constraints that it can occasionally assume a form entirely contrary to the principles of biological evolution. The second model attributes suicide to a breakdown of adaptive mechanisms in extremely stressful novel environments. The third model involves kin and group selection, arguing that in limited circumstances suicide may occur because of beneficial effects it has on other, surviving individuals who share the suicidal individual's genes. The last model suggests that suicide should be tolerated by evolution when it has no effect on the gene pool. This model holds particular promise in accounting for aspects of suicide not attributable to culture. The evidence indicates that suicide is most common in individuals who are unlikely to reproduce and unable to engage in productive activity; such individuals are least capable of promoting their genes. A complete explanation of suicide may derive only from an analysis of its biological significance. (shrink)

The standard of care in the United States favors stabilizing any adult who arrives in an emergency department after a failed suicide attempt, even if he appears decisionally capacitated and refuses life‐sustaining treatment. I challenge this ubiquitous practice. Emergency clinicians generally have a moral obligation to err on the side of stabilizing even suicide attempters who refuse such interventions. This obligation reflects the fact that it is typically infeasible to determine these patients’ level of decisional capacitation—among other relevant (...) information—in this unique setting. Nevertheless, I argue, stabilizing suicide attempters over their objection sometimes violates a basic yet insufficiently appreciated right of theirs—the right against bodily invasion. In such cases, it is at least prima facie wrong to stabilize a patient who wants to die even if they lack a contrary advance directive or medical order and suffer from no terminal physical illness. (shrink)

While suicide is typically associated with personal despair, people do sometimes kill themselves in the hope or expectation that their death will advance a political cause by way of its impact on the conscience of others, or in extreme cases simply as an expression of protest against a status quo felt to be unjust. Paradigm cases of such protest suicide may be public acts of self-immolation. This chapter distinguishes between instrumental and expressive protest suicide, examines the possible (...) motivations behind them, their possible moral justification, and their potential contribution to the meaning of the suicide’s life. It argues that when the value of the aim pursued by way of instrumental suicide is proportionate, killing oneself promotes it sufficiently, and other morally acceptable options are exhausted, instrumental protest suicide can be morally permissible and consistent with human dignity. It can even be an admirable act of self-sacrifice, provided that the agent’s motivations are suitable. Some of the standard moral objections to suicide don’t apply to such cases. But protest suicide remains morally risky, because one might be mistaken about the worth of one’s cause or the availability of alternatives, and because even these extreme acts typically have limited effect. (shrink)

Philosophical discussions of the morality of suicide have tended to focus on its justifiability from an agent’s point of view rather than on the justifiability of attempts by others to intervene so as to prevent it. This paper addresses questions of suicide intervention within a broadly Kantian perspective. In such a perspective, a chief task is to determine the motives underlying most suicidal behaviour. Kant wrongly characterizes this motive as one of self-love or the pursuit of happiness. Psychiatric (...) and scientific evidence suggests that suicide is instead motivated by a nihilistic disenchantment with the possibility of happiness which, at its apex, results in the loss of the individual’s conception of her practical identity. Because of this, methods of intervention that appeal to agents’ happiness, while morally benign, will prove ineffective in forestalling suicide. At the same time, more aggressive methods violate the Kantian concern for autonomy. This apparent dilemma can be resolved by seeing suicide intervention as an action undertaken in non-ideal circumstances, where otherwise unjustified manipulation, coercion, or paternalism are morally permitted. (shrink)

Derek Parfit’s view of ‘personal identity’ raises questions about whether advance decisions refusing life-saving treatment should be honored in cases where a patient loses psychological continuity; it implies that these advance decisions would not be self-determining at all. Part I of this paper argues that this assessment of personal identity undermines the distinction between suicide and homicide. However, rather than accept that an unknown metaphysical ‘further fact’ underpins agential unity, one can accept Parfit’s view but offer a different account (...) of what it implies morally: that the social and legal bases for ascribing a persisting ‘personal identity’ maintain the distinction between homicide and suicide. (shrink)

Suicide is devastating. It is an assault on our ideas of what living is about. In Contemplating Suicide Gavin Fairbairn takes fresh look at suicidal self harm. His view is distinctive in not emphasising external facts: the presence or absence of a corpse, along with evidence that the person who has become a corpse, intended to do so. It emphasises the intentions that the person had in acting, rather than the consequences that follow from those actions. Much of (...) the book is devoted to an attempt to construct a natural history of suicidal self harm and to examine some of the ethical issues that it raises. Fairbairn sets his philosophical reflections against a background of practical experience in the caring professions and uses a storytelling approach in offering a critique of the current language of self harm along with some new ways of thinking. Among other things he offers cogent reasons for abandoning the mindless use of terms such as attempted suicide and parasuicide , and introduces a number of new terms including cosmic roulette , which he uses to describe a family of human acts in which people gamble with their lives. By elaborating a richer model of suicidal self harm than most philosophers and most practitioners of caring professions currently inhabit, Fairbairn has contributed to the development of understanding in this area. Among other things a richer model and vocabulary may reduce the likelihood that those who come into contact with suicidal self harm, will believe that familiarity with the physical facts of the matter - the actions of the suicider and the presence or absence of a corpse - is always sufficient to justify a definite conclusion about the nature of the self harming act. (shrink)

Contributors explore the social, medical, and ethical dilemma of assisted suicide in this revised edition that includes international as well as domestic viewpoints. The federal government's continued challenges to Oregon's Death with Dignity Act, the disabled community's response to assisted suicide, and the slippery slope argument are all examined.

En 1994, Sue Rodriguez se suicide avec l’aide d’un médecin après une intense bataille judiciaire en Cour suprême du Canada dont l’objet était la décriminalisation du suicide assisté. À la suite de ce suicide, aucune accusation criminelle ne fut portée contre la ou les personnes ayant présumément aidé Sue Rodrigues à mettre fin à ses jours, et ce malgré le fait que le suicide assisté est un acte criminel au Canada. Cette non-intervention du droit pénal est (...) examinée en fonction du rôle que l’affaire Rodriguez a pu jouer dans la transformation des moralités au Canada. Dans ce livre, le suicide assisté de Sue Rodriguez est envisagé comme un « crime » utile (au sens durkheimien du terme), car il met en évidence une inconsistance entre les moralités dominantes inscrites dans le droit pénal et les conditions sociales qui ont rendu ce « crime » possible. Apparenté au crime de Socrate, le « crime » de Sue Rodriguez est analysé comme un héraut annonciateur de nouvelles moralités, comme un prélude préparant directement la voie à des changements dans le poids accordé aux moralités dominantes. Dans ce contexte, le rôle du droit pénal comme mode privilégié de régulation morale est remis en question. (shrink)

As medical technology advances and severely injured or ill people can be kept alive and functioning long beyond what was previously medically possible, the debate surrounding the ethics of end-of-life care and quality-of-life issues has grown more urgent. In this lucid and vigorous book, Craig Paterson discusses assisted suicide and euthanasia from a fully fledged but non-dogmatic secular natural law perspective. He rehabilitates and revitalises the natural law approach to moral reasoning by developing a pluralistic account of just why (...) we are required by practical rationality to respect and not violate key demands generated by the primary goods of persons, especially human life. Important issues that shape the moral quality of an action are explained and analysed: intention/foresight; action/omission; action/consequences; killing/letting die; innocence/non-innocence; person/non-person. Paterson defends the central normative proposition that ’it is always a serious moral wrong to intentionally kill an innocent human person, whether self or another, notwithstanding any further appeal to consequences or motive’. (shrink)

Assisting suicide is legal in Switzerland if it is offered without selfish motive to a person with decision-making capacity. Although the ‘Swiss model’ for suicide assistance has been extensively described in the literature, the formally and informally protected liberties and claims of assistors and recipients of suicide assistance in Switzerland are incompletely captured in the literature. In this article, we describe the package of rights involved in the ‘Swiss model’ using the framework of Hohfeldian rights as modified (...) by Wenar. After outlining this framework, we dissect the rights involved in suicide assistance in Switzerland, and compare it with the situation in England and Germany. Based on this approach, we conclude that in Switzerland, claim rights exist for those requesting suicide assistance, and for those who are considering providing such assistance, even though no entitlements exist toward suicide assistance. We then describe the implementation of the ‘Swiss model’ and difficulties arising within it. Clarifying these issues is important to understand the Swiss situation, to evaluate what features of it may or may not be worth correcting or emulating, and to understand how it can impact requests for suicide assistance in other countries due to ‘suicide tourism’. It is also important to understand exactly what sets Switzerland apart from other countries with different legislations regarding suicide assistance. (shrink)

Assisting suicide is legal in Switzerland if it is offered without selfish motive to a person with decision-making capacity. Although the ‘Swiss model’ for suicide assistance has been extensively described in the literature, the formally and informally protected liberties and claims of assistors and recipients of suicide assistance in Switzerland are incompletely captured in the literature. In this article, we describe the package of rights involved in the ‘Swiss model’ using the framework of Hohfeldian rights as modified (...) by Wenar. After outlining this framework, we dissect the rights involved in suicide assistance in Switzerland, and compare it with the situation in England and Germany. Based on this approach, we conclude that in Switzerland, claim rights exist for those requesting suicide assistance, and for those who are considering providing such assistance, even though no entitlements exist toward suicide assistance. We then describe the implementation of the ‘Swiss model’ and difficulties arising within it. Clarifying these issues is important to understand the Swiss situation, to evaluate what features of it may or may not be worth correcting or emulating, and to understand how it can impact requests for suicide assistance in other countries due to ‘suicide tourism’. It is also important to understand exactly what sets Switzerland apart from other countries with different legislations regarding suicide assistance. (shrink)

Among contemporary philosophers, David Benatar espouses a form of pessimism most closely aligned with Schopenhauer’s. Both maintain that human existence is a misfortune, such that each of us would have been better off having never existed at all. Here my concerns are twofold: First, I investigate why, despite these similarities, Schopenhauer and Benatar arrive at divergent positions regarding suicide. For whereas Benatar concludes that suicide is sometimes a moral wrong to others but is prudentially rational in a wider (...) array of circumstances than we ordinarily expect, Schopenhauer largely sets aside questions of both interpersonal morality and prudence to argue that suicide is self-contradictory or futile because it does not undermine the metaphysical facts concerning the place of will in human life, facts ultimately responsible for our unfortunate condition. Second, I consider Schopenhauer’s attempt to show that suicide is a mistaken response to human suffering. Under any of several plausible interpretations of Schopenhauer’s argument that suicide is a futile exercise, his reasoning is unconvincing. Drawing upon Schopenhauer’s admiration for ‘ascetic’ suicide, I then propose an alternative expressive route for Schopenhauer: that suicide is usually mistaken because it fails to manifest integrity in light of the unfortunate truth about the human condition. (shrink)

Suicidal Thoughts is a compilation of some of the most moving and insightful writing accomplished on the topic of suicide. It presents the thoughts and experiences of fifteen writers who have contemplated suicide-some on a professional level, others on a personal level, and a few, both personally and professionally. Through this collection, the reader is able to bear witness to the struggle between life and death and to the devastating aftermath of suicide. Suicidal Thoughts provides readers with (...) a better understanding of the reasons why some individuals give serious consideration to killing themselves. (shrink)

Richard Brandt, following Hume, famously argued that suicide could be rational. In this he was going against a common ‘absolutist’ view that suicide is irrational almost by definition. Arguments to the effect that suicide is morally permissible or prohibited tend to follow from one’s position on this first issue of rationality. I want to argue that the concept of rationality is not appropriately ascribed – or withheld – to the victim or the act or the desire to (...) commit the act. To support this, I explore how the concept is ascribed and withheld in ordinary situations, and show that it is essentially future-oriented. Since the suicide victim has no future, it makes no sense to call his act rational or irrational. The more appropriate reaction to a declared desire for suicide, or to the news of a successful suicide, is horror and pity, and these are absent from Brandt’s account, as is a humble acknowledgement of the profound mystery at the heart of any suicide. (shrink)

This chapter explores some of the major developments in the philosophical understanding of suicide in 19th Century Western thought. Two developments in particular are considered. The first is a widespread shift towards thinking about suicide in medical terms rather than moral terms. Deploying methods initiated by a number of French and German thinkers in the preceding century who worked at the then emerging interface between the social and biological sciences, a number of 19th century thinkers ejected what they (...) took to be old metaphysical superstitions about ‘good’ and ‘evil’, and replaced them with (allegedly) hard-nosed scientific diagnoses of ‘health’ and ‘sickness’. Dismissing traditional moral arguments against the permissibility of suicide, the phenomenon came to be viewed as a symptom of decline or degeneration. How variations of this view, in biological and social contexts, reorientated practical responses to suicide in terms of treatment rather than moral condemnation is explored. The second 19th century development in philosophical thought with respect to suicide the chapter considers concerns its place in one of the most significant controversies in Germany from 1860 to the turn of the century: the Pessimismusstreit or ‘pessimism dispute’. While philosophical pessimism might be thought to vindicate or even entail suicide, many of the most prominent pessimists—including Arthur Schopenhauer and Eduard von Hartmann—denied that this was the case, and perhaps surprisingly took suicide to involve a special kind of moral and/or epistemic failing. The chapter aims to elucidate the different arguments which pessimists appealed to in order to ground this position. (shrink)

Kevin Yuill goes straight to the heart of a difficult issue. Critical of both sides of the discussion, this book presents an up-to-date analysis of the direction discussion is taking, showing that atheists, libertarians, those favouring abortion rights and stem-cell research should stand beside their religious compatriots in opposing legalization of assisted suicide. The author shows that the real issue behind the debate is not euthanasia but suicide. Rather than focusing on tragic cases, he indicates the real damage (...) that will be done if we affirm the suicidal wishes of even a small segment of the population. Analyzing the movement for the right to die in historical terms, Yuill shows that, though many proponents of a change in the law believe they are rationalist heirs of such thinkers as John Stuart Mill, legalizing assisted suicide will reduce privacy and freedom. Finally, Yuill suggests a radical alternative to legalization of assisted suicide that would embrace both the cause of freedom and the anxieties of many about securing good deaths. (shrink)

Defends Kantian paternalism: Interference with an individual’s liberty for her own sake is justified absent her actual consent only to the extent that such interference stands a reasonable chance of preventing her from exercising her liberty irrationally in light of the rationally chosen ends that constitute her conception of the good. More specifically, interference with an individual’s liberty is permissible only if, by interfering, we stand a reasonable chance of preventing that agent from performing actions she chose due to distorted (...) reasoning and which would result in that agent’s rationally chosen ends not being as fully realized as they would have been had she so acted. -/- Applied to suicide intervention Kantian paternalism implies that such intervention is justified to the extent that it prevents a person from ending her life when, due to distorted reasoning, she engages in suicidal behavior that is at odds with her rationally chosen ends. (shrink)

In Europe the elderly population is projected to increase from 18.5% (93.9 million) in 2014 to 28.7% (149.1 million) by 2080. In the USA it is estimated that by the year 2030 more than 20% of the population will be aged 65 years or over. This specific population is at high risk of unrecognised or untreated psychiatric illnesses and suicide. It is well known that completed suicide rate increases with age in both men and women. Although elderly people (...) attempt suicide less often than other age groups, they show a higher completion rate. Generally the methods chosen by elderly are more lethal, the intent is more serious, they are more determined and they show fewer warning sign than the younger population. A recent systematic review and meta-analysis of psychosocial intervention following self-harm in adults found that cognitive behavioural therapy was the most effective in these patients. Unfortunately there have been few reported trials of other potentially effective interventions. Because the scientific literature on psychosocial suicide prevention interventions in the elderly is still scant we decided to conduct a mini-review in order to take stock of the situation. Studies were identified through electronic searches of the Cochrane library, MEDLINE, Scopus and Web of Science databases. PRISMA guidelines were followed and only 7 articles met the inclusion criteria. No firm conclusions can be drawn about this topic because there is still little data and studies used inconsistent outcome measures and designs. Nonetheless, the existing data suggests that psychosocial interventions are promising. (shrink)

A 62-year-old female with Huntington’s disease presented after a suicide attempt. Her advance directive stated that she did not want intubation or resuscitation, which her family acknowledged and supported. Despite these directives, she was resuscitated in the emergency department and continued to state that she would attempt suicide again. Her suicidality in the face of a chronic and advancing illness, and her prolonged consistency in her desire to take her own life, left careproviders wondering how to provide ethical, (...) respectful care to this patient. Tension between the ethical principles of autonomy and beneficence is central in this case. The patient’s narrative demonstrated that her suicide was an autonomous decision, free from coercion or disordered thinking from mental illness. Beneficence then would seem to necessitate care aligned with the patient’s desire to end her life, which created ethical uneasiness for her family and careproviders. The case highlights several end-of-life ethical considerations that have received much recent attention. With ongoing discussions about the legalization of aid in dying across the country, caregivers are challenged to understand what beneficence means in people with terminal illnesses who want a say in their death. This case also highlights the profound moral distress of families and careproviders that arises in such ethically challenging scenarios. (shrink)

Kant has famously argued that human beings or persons, in virtue of their capacity for rational and autonomous choice and agency, possess dignity, which is an intrinsic, final, unconditional, inviolable, incomparable and irreplaceable value. This value, wherever found, commands respect and imposes rather strict moral constraints on our deliberations, intentions and actions. This paper deals with the question of whether, as some Kantians have recently argued, certain types of (physician-assisted) suicide and active euthanasia, most notably the intentional destruction of (...) the life of a terminally-ill, but rational and autonomous patient in order to prevent certain serious harms, such as enduring or recurring pain or the loss of the meaning in life, from befalling him really are inconsistent with respect for the patient’s human dignity. I focus on two independent, though interrelated explications of the rather vague initial idea that the patient (as well as the doctor), in intending and bringing about his death, treats his person or rational nature merely as a means and so denigrates his dignity: (i) that in doing what he is doing, he does not act for the sake of his person, but for the sake of something else; (ii) that, by trading his person for pain relief, he engages himself in an irrational and hence immoral exchange. After critically discussing some suggestions about how to understand this charge, I eventually find Kantian objections to suicide and (active) euthanasia, based on the idea of human dignity, less than compelling. For all the paper proves, suicide and (active) euthanasia may still be morally impermissible, but then this must be so for some other reason than the one given above. (shrink)

To accept a notion of rational suicide, as many contemporary bioethicists now urge, first makes possible certain kinds of manipulation into suicide which do not occur in suicide-impermissive societies. This paper describes the two principal mechanisms by which an individual can be manipulated into choosing to kill himself or herself, though that individual would not have done so otherwise, and identifies circumstantial and ideological changes in contemporary society which may be associated with such manipulation now and in (...) the future. However, the author holds that this prospect is not grounds for rejecting the notion of rational suicide;it must be accepted on other moral grounds, but with a clear view of the risks it will bring. (shrink)

In an original and provocative study of suicide, Ian Marsh examines the historical and cultural forces that have influenced contemporary thought, practices and policy in relation to this serious public health problem. Drawing on the work of French philosopher Michel Foucault, the book tells the story of how suicide has come to be seen as first and foremost a matter of psychiatric concern. Marsh sets out to challenge the assumptions and certainties embedded in our beliefs, attitudes and practices (...) concerning suicide and the suicidal, and the resulting account unsettles and informs in equal measure. The book will be of particular interest to researchers, professionals and students in psychology, history, sociology and the health sciences. (shrink)

Kant formulated a secular argument against suicide’s permissibility based on what he regarded as the intrinsic value of humanity. In this paper, I first show that Kant’s moral framework entails that some types of suicide are morally permissible. Just as some homicides are morally permissible, according to Kant, so are suicides that are performed according to equivalent maxims. Intention, foreseeability, voluntariness, diminished responsibility, and mental capacity determine the moral characterization of the killing. I argue that a suicide (...) taxonomy that differentiates types of suicide according to morally relevant criteria is compatible with Kantian ethics; it establishes that even where we hold a robust deontological sanctity of life position, we are not obligated to preserve the lives of people whose future life only offers profound suffering, and helping them to die may be justifiable if doing so honors their dignity and autonomy. Nevertheless, homicide and suicide are only weakly morally symmetrical in that even if a given suicide is morally impermissible, we do not normally have the right to prevent it forcibly, though this may be altered by juridical laws under some circumstances. (shrink)

Suicide, as one of the leading causes of death for the adolescent population, both in Chile and globally, remains a complex and elusive phenomenon. This research studies the association between positive and negative affect in relation with suicidal ideation and suicidal attempt, given that affectivity is a fundamental basis on which people make evaluations on their satisfaction with life. First, it examines the reliability, structure, and validity of Watson’s positive and negative affect scale (PANAS) scale in a representative random (...) sample of Chilean high school students (N= 4,568). The scale evidences strong reliability coefficients and a confirmatory factor analysis, excluding one positive (excited) and one negative (nervous) item. The scale shows a satisfactory goodness of fit. Secondly, it investigates the association of PANAS positive and negative affect scores with suicidal ideation as well as reported attempt in adolescents, controlling for the potential effect of age and sex (N= 420 high school students). Low positive and high negative affect, but not sex and age, show a significant association with suicidal ideation. Suicidal ideation totally mediates the association of affect with suicide attempt, as expected. Results are discussed regarding prevention and it considers how positive and negative affect can be relevant as indicators for prevention and treatment using widely available technology. (shrink)

The concept of rational suicide argues that suicide could be a rational choice, in certain circumstances. Such an argument faces criticism when there is an accompanying mental illness, as many view suicide as a symptom of mental illness rather than as a rational choice about one's life. More specifically, the rational suicide debate has mostly excluded individuals with schizophrenia, as it is widely seen as a disorder that impairs rational decision making. This paper aims to examine (...) the concept of rational suicide in schizophrenia: Could it be possible that some acts of suicide are driven from a rational choice by patients suffering from schizophrenia? This paper does not include discussions related to physician-assisted dying in schizophrenia. (shrink)

Kantian defenders of suicide for the soon-to-be demented claim that killing oneself would protect rather than violate a person’s inherent worth. The loss of cognitive functions reduces someone to a lower moral status, so they believe that suicide is a way of preserving or preventing the loss of dignity. I argue that they misinterpret Kant’s examples and fail to appreciate the reasons behind his absolute prohibition on suicide. Although Kant says that one may have to sacrifice one’s (...) life to fulfill a moral duty, suicide is not morally equivalent to self-sacrifice because it involves treating oneself merely as a means. Furthermore, people facing the onset of dementia would not protect their dignity by killing themselves while they are still rational and would not avoid a demeaning existence. (shrink)

Slippery slope argumentation features prominently in debates over assisted suicide. The jurisdiction of Oregon features prominently too, especially as regards parliamentary scrutiny of assisted suicide proposals. This paper examines Oregon’s public data (including certain official pronouncements) on assisted suicide in light of the two basic versions of the slippery slope argument, the empirical and moral-logical versions. Oregon’s data evidences some normatively interesting shifts in its assisted suicide practice which in turn prompts consideration of two elements of (...) moral-logical slippage that are not widely discussed. One is slippage from an initial autonomy-based public justification for assisted suicide which does not include burden-based concerns within its operative account of voluntariness to an evolved public justification that does. The other is an expansion of a terminal illness ground to include chronic illnesses effectively rendered terminal via a refusal of treatment. (shrink)

The ethical problems surrounding voluntary assisted suicide remain formidable, and are unlikely to be resolved in pluralist societies. An examination of historical attitudes to suicide suggests that modernity has inherited a formidable complex of religious and moral attitudes to suicide, whether assisted or not. Advocates usually invoke the ending of intolerable suffering as one justification for euthanasia of this kind. This does not provide an adequate justification by itself, because there are (at least theoretically) methods which would (...) relieve suffering without causing the physical death of the suffering person. Carried to extremes, these methods would finish the life worth living, but leave a being which was technically alive. Such acts, however, would provide no moral escape, since they would create beings without meaning. Arguments seeking to justify ending the lives of others need some grounding in concepts of the meaning of a life. The euthanasia discourse therefore needs to take at least some account of the meaning we construct for our lives and the lives of others. (shrink)

Suicide is devastating. It is an assault on our ideas of what living is about. In Contemplating Suicide Gavin Fairbairn takes fresh look at suicidal self harm. His view is distinctive in not emphasising external facts: the presence or absence of a corpse, along with evidence that the person who has become a corpse, intended to do so. It emphasises the intentions that the person had in acting, rather than the consequences that follow from those actions. Much of (...) the book is devoted to an attempt to construct a natural history of suicidal self harm and to examine some of the ethical issues that it raises. Fairbairn sets his philosophical reflections against a background of practical experience in the caring professions and uses a storytelling approach in offering a critique of the current language of self harm along with some new ways of thinking. Among other things he offers cogent reasons for abandoning the mindless use of terms such as attempted suicide and parasuicide , and introduces a number of new terms including cosmic roulette , which he uses to describe a family of human acts in which people gamble with their lives. By elaborating a richer model of suicidal self harm than most philosophers and most practitioners of caring professions currently inhabit, Fairbairn has contributed to the development of understanding in this area. Among other things a richer model and vocabulary may reduce the likelihood that those who come into contact with suicidal self harm, will believe that familiarity with the physical facts of the matter - the actions of the suicider and the presence or absence of a corpse - is always sufficient to justify a definite conclusion about the nature of the self harming act. (shrink)

In this paper, we address the question of whether AI should be used for suicide prevention on social media data. We focus on algorithms that can identify persons with suicidal ideation based on their postings on social media platforms and investigate whether private companies like Facebook are justified in using these. To find out if that is the case, we start with providing two examples for AI-based means of suicide prevention in social media. Subsequently, we frame suicide (...) prevention as an issue of beneficence, develop two fictional cases to explore the scope of the principle of beneficence and apply the lessons learned to Facebook’s employment of AI for suicide prevention. We show that Facebook is neither acting under an obligation of beneficence nor acting meritoriously. This insight leads us to the general question of who is entitled to help. We conclude that private companies like Facebook can play an important role in suicide prevention, if they comply with specific rules which we derive from beneficence and autonomy as core principles of biomedical ethics. At the same time, public bodies have an obligation to create appropriate framework conditions for AI-based tools of suicide prevention. As an outlook we depict how cooperation between public and private institutions can make an important contribution to combating suicide and, in this way, put the principle of beneficence into practice. (shrink)

It appears that the attitudes of health professionals differ towards suicide and voluntary active euthanasia. An acceptance of, if not an agreement with, voluntary active eutha nasia exists, while there is a general consensus that suicide should be prevented. This paper searches for a working definition of suicide, to discover ethical reasons for the negative value that suicide assumes, and also to provide a term of reference when comparing suicide with euthanasia. On arriving at a (...) working definition of suicide, it is compared with voluntary active euthanasia. An analysis of utilitarian and deontological considerations is provided and proves to be inconclusive with respect to the ethical principles informing the attitudes of professionals. Therefore, a search for other influences is attempted; this indicates that psychological influences inform attitudes to a greater degree than ethical principles. (shrink)

According to the “discrimination argument,” it would be discriminatory and hence impermissible to categorically exclude people with mental illness (PMI) from access to assisted suicide (AS) if AS is accessible to people with somatic illnesses. In objection to this, it could be argued that excluding PMI is not discriminatory, but rather based on their inability to meet certain eligibility criteria for AS. Which criteria are deemed necessary depends on the approach taken to justifying AS. In this article, we describe (...) two distinct ethical approaches to justifying AS and the eligibility criteria they entail and examine whether PMI can fulfill these criteria. A widespread “joint” approach based on beneficence and autonomy assumes that AS is justified when it alleviates the severe and irremediable suffering of a person who autonomously requests AS. An alternative, exclusively autonomy‐based approach assumes that providing AS is justified when a person's request is autonomous, regardless of whether AS is in her best interests. The latter approach underlies an important judgment of the German Federal Constitutional Court from 2020. We argue that PMI can in principle fulfill both beneficence‐ and autonomy‐based eligibility criteria for AS, and that a blanket exclusion of all PMI from AS is thus discriminatory on either approach. However, depending on which approach is taken, there are differences regarding the subgroups of PMI that would be eligible for AS. Whether the exclusion of specific PMI is discriminatory therefore depends on how we understand and justify AS. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases. Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s. Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz (E) and Dignitas (D) between 2001 (...) and 2004 and investigated by the University of Zurich’s Institute of Legal Medicine (E: n = 147; D: n = 274, total: 421). Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 (n = 149) were compared with the data of the present study. Results: More women than men were assisted in both organisations (D: 64%; E: 65%). Dignitas provided more assistance to non-residents (D: 91%; E: 3%; p = 0.000), younger persons (mean age in years (SD): D: 64.5 (14.1); E: 76.6 (13.3); p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis (D: 79%; E: 67%; p = 0.013). Lethal medications were more often taken orally in cases assisted by Dignitas (D: 91%; E: 76%; p = 0.000). The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s (women: 52% to 65%, p = 0.031; mean age in years (SD): 69.3 (17.0) to 76.9 (13.3), p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026). Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases.Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s.Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz and Dignitas between 2001 and 2004 and investigated (...) by the University of Zurich’s Institute of Legal Medicine. Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 were compared with the data of the present study.Results: More women than men were assisted in both organisations. Dignitas provided more assistance to non-residents, younger persons : D: 64.5 ; E: 76.6 ; p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis. Lethal medications were more often taken orally in cases assisted by Dignitas. The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s : 69.3 to 76.9, p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026).Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)