Louisville Medicine Volume 64, Issue 5 | Página 8

PHYSICIANS AND SUICIDE: EXPLORING OUR ROLES IN PREVENTION, OUR RISK AND THE ETHICS OF ENABLING Mary Helen Davis MD, DFAPA W hat as physicians is our relationship to suicide? Suicide, the act of intentionally causing one’s own death, is generally associated with psychological distress or mental illness. Attitudes toward suicide have encompassed everything from sin to personal choice. The past decade has seen an increasing number of states pass Physician Assisted Suicide legislation. Physician Assisted Suicide is defined when a physician facilitates death by providing necessary means or information for a patient to complete suicide. Euthanasia is the intentional administration of a drug with the purpose of hastening death. The AMA stance has found this to be fundamentally incompatible with the physician's role as healer. However, medical subspecialties are grappling with their position statements on this topic and several have come out with statements of neutrality. Slightly over 10 percent of physicians have reported receiving requests for either physician assisted suicide or euthanasia. The majority of these cases involve patients with terminal illness such as cancer, ALS, AIDS or a chronic progressive neurological disorder. 6 LOUISVILLE MEDICINE Expanded assisted suicide criteria in the Netherlands have raised concerns about an ethical slippery slope, especially in the case of the clinic that helps those chronically depressed to end their lives. Approximately 36,000 people die of suicide annually, roughly twice the number of those murdered annually. As physicians, our role has traditionally been the saving of lives. For psychiatrists, identifying the risk factors of suicide, engaging in suicide prevention and treating the disorders that contribute to suicidal behavior are key elements of our profession. Douglas Jacobs, MD, has developed SAFE-T, the Suicide Assessment Five-step Evaluation and Triage. This scale identifies risk factors, protective factors, how to conduct an inquiry, determine risk level, and intervention and documentation. A downloadable card can be found at shiacmh. org/docs/safe-t.pdf. All physicians need to be versed in identifying risk factors and making basic assessments and referrals for more intensive interventions when needed. Recent research has implicated inflammatory and infectious disease in both depressive states and suicidal behavior. Proinflammatory cytokines and inflammatory metabolites increase risk for suicidal behavior. A large Danish