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‘We urgently need to expand our thinking on suicide and respect human autonomy’

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By refusing to accept some suicides as rational acts, we condemn people to lonely deaths and place healthcare professionals in invidious positions, says Jane Wright

Suicide has meant different things, at different times, in different cultures. In eastern cultures it has signified protest, sacrifice or honourable death. For example, sati – the practice among some Hindu communities in which a widow would immolate herself on her husband’s funeral pyre – was thought to ensure entry to heaven and ancestral redemption.

Conversely, western culture has been largely censorious of suicide considering it an immoral and, until 1961 in the UK, an illegal act.

In recent decades, however, there has been a shift towards a more sympathetic attitude, associating suicide with mental illness. The result is that suicide is now labelled as a mental health phenomenon, that can be addressed by setting targets for reduction in suicide rates. But how achievable is this?

Northern Ireland has a reduction target of 15% by the end of 2011. In order to achieve this nurses and doctors must alleviate the intolerable physical, mental or emotional pain that can lead a person to take their own life. Logically, either medical professionals are limited in their ability to alleviate misery and eradicate unhappiness – and therefore setting targets is a rather pointless exercise – or they can alleviate suffering and, if so, why limit the target to 15%? Why not 100%?

The reality is suicide cannot be eradicated. It cannot even be controlled. Suicide rates ebb and flow. There may be clusters of suicides which, according to Malcolm Gladwell, author of The Tipping Point, occur because one suicide gives ‘permission’ to others. Suicide may result from a single act of harm or from many acts of self-harm such as the slow suicide of alcoholism.

There are many reasons why individuals choose to end their life, from the drink or drug-fuelled ‘impulse’ suicide to the considered and rational suicide of those for whom life no longer holds any hope. But those who label suicide as a mental health problem fail to recognise that suicide can be a logical action. By fostering the illusion that suffering is always curable or noble we fail to respect human autonomy and add to the plight of those such as Diane Pretty, whose considered decision to end her suffering from motor neuron disease in 2002 was not respected by the courts.

For professionals too, the refusal to acknowledge some suicides as rational actions can lead to professional difficulties. Last month the General Medical Council suspended Glasgow GP Dr Iain Kerr because he had prescribed drugs with the intent of allowing a patient to end their own life.

He did not want to kill his patient but believed it was his patient’s choice and that physician-assisted dying should be an option, as it is in some circumstances in Oregon and the Netherlands. Although this doctor acted to procure a painless death he was deemed to have acted in an unacceptable manner because the House of Lords had rejected a bill permitting assisted dying for the terminally ill in 2006.

Thus, as a result of the legislation, the individual ending their life must do so alone, and without access to a pain-free method of doing so, and professionals who seek to assist those who no longer wish to live risk their careers.

We desperately need to expand our thinking on our attitudes to suicide rather than continuing to view it as a deviant act perpetrated only by those without sound judgement. And we nurses must also consider not just how we can alleviate the suffering of those who want to live but also the suffering of those who want to die. If we do this, we will no longer condemn this small minority to lonely deaths by often painful methods. I do not argue, though, for an abrogation of the responsibilities involved.

Author Carmen Callil wrote that ‘people who commit suicide are not alone: they are addressing someone’. Every suicide should address us as nurses, and as members of society, not just to help others to find happiness where they can or comfort those in pain but to see people’s deaths – as well as their lives – as worthy of respect.

Jane Wright is nurse education consultant at Beeches Management Centre, Belfast

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