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.
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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