Assisted suicide
Euthanasia and (assisted) suicide are being increasingly put on an equal footing.
Although to the letter of the law it still being legally forbidden, euthanasia is increasingly being provided by non-medics, so more and more psychiatric nurses can be expected to be called upon to assist with suicide.
Suicide is an extremely radical, irreversible deed taken by someone who for whatever reason no longer can or wants to live. Sometimes the surroundings can anticipate it or the person in question is so pre-occupied with it that it is (sooner or later) to be expected. It is usually unexpected and the surviving family are totally confounded.
Motive
How does someone come so far as to commit suicide?
Suicide can be a direct consequence of a psychiatric disease (hallucinations, delusions, terrible thoughts, a depression), or the consequence of ‘serious, unbearable, usually long-term psychological/psychiatric (sometimes physical) suffering’.
However, it is often also an (ultimate) means of achieving a particular goal (end of suffering: balance-suicide; cry for help, love or understanding), from revenge (the intentional wish to cause the surroundings or surviving family intense feelings of guilt) or from pure despair, whether or not on an impulse. Balance-suicide means suicide that is done after the person in question has weighed all the pros and cons and has come to the conclusion that in the given situation, he/she is best benefited with a self-chosen death, with all the consequences thereof.
For the person in question, suicide normally means an end to what is experienced as unbearable (psychological) suffering. This is of course seen from the perspective that, even if there is an existence after this life, it cannot be worse than the situation at the time of suicide.
For the surviving family this nearly always means the beginning or the worsening of suffering and it has a great - lifelong - impact! A suicide note can sometimes explain a lot, but sometimes it can also injure surviving family even more. Often, the surroundings are left with feelings of guilt and questions. Usually the surviving family are avoided because of the shame it arouses by many people, but especially because bystanders don't know how to deal with the situation and how to react. This is an extra burden for the surviving family. After a suicide there is a greater chance of a disturbed grieving period among the surviving family!
Prevention
Prevention of suicidal behaviour is very important.
Research shows that people who have once attempted suicide, have a greatly increased risk of making another attempt. The following attempts are usually more serious / more dangerous, so that it can eventually still end in death.
An important proportion of suicides could probably be prevented, because it often involves psychological disturbances that can be treated. If they are successfully treated, the entire will to die is cancelled.
A (non-fatal) attempted suicide often has all sorts of harmful consequences; such as physical and/or cognitive damage, sometimes as a consequence of the overdose/poisoning, failed hanging, or near fatal injury.
Many attempts lead to hospitalisation and result in stigmatisation; they may form the start of a psychiatric career.
With suicide prevention, the surviving family should also be taken into consideration: Every year, more than 1500 people commit suicide in the Netherlands (registered suicides). Assuming that at least an average of five people are closely involved with one suicide victim, then on a yearly basis the lives of more than 7,500 people will be seriously influenced or defined by it.
Timely recognition of the preceding stages (suicidal behaviour) is an important instrument for prevention.
A Christian (aid worker) confesses that God defines the start and end of life. For this reason alone, it is an unjust deed to decide one's self the time and manner of death. If a patient is no longer able to guarantee his own life, then the aid worker and the aid institution must protect him from himself.
On suspicion of suicide (and this happens much more often than one would think!) it is of great importance to ask probing questions as to the extent that someone is occupied with it; people will not volunteer the information. Stay in contact (don't use expressions like ‘just think about...’) and arrange professional help.
Suicidal behaviour
This means thinking and fantasising about death, especially a self-chosen death. This occurs especially when people see no escape from the situation in which they have become stuck. The frequency and severity may vary: from thinking about it once to making concrete plans about how, where and when. These thoughts and fantasies may (entirely) dominate the (at that time limited) world of experience. This can give rise to the idea that suicide is the only thing left for ending a condition or situation. In the psychological world, this view is usually dominant at the expense of religious belief.
Risk factors
Several simultaneous factors significantly increase the risk!
- depression, psychiatric disorder
- alcohol/drugs misuse
- recent or longer ago: traumatic life event, incest, sexual abuse
- illness, recent loss, deportation (asylum seekers), loss of status
- loneliness/social isolation; being bullied
- deviance (deviant behaviour; not belonging anywhere)
- suicidal communications, suicidal preparations
- suicidal model in the surroundings
- earlier attempted suicide
Suicide in a cultural-historic perspective
Negative status
The opinions on suicide have been somewhat subject to change:
The accusation of egoism: ‘It is someone who lets their own will, desires, emotions and problems prevail over that of others and/or society’.
Disobedience towards God: Breaking the commandment 'Thou shalt not kill’; ‘God proposes and disposes, you must wait until your time has come’.
Sometimes attempted suicide was punished with the death penalty and slaves were not permitted to commit suicide. The punishments were sometimes bewildering: the body of someone who had taken their own life was dishonoured and executed. Often a fork or stake was thrust through the body and it was exhibited, hung up by the feet.
The family or surviving family were dishonoured. Their goods were confiscated. If the body was buried at all, it was done outside the cemetery walls, in ‘unconsecrated’ soil. Sometimes the body was just thrown away somewhere as prey for the wild beasts.
Positive status
Some cultures had (and sometimes still have) the so-called institutional suicides:
These are suicides that under certain circumstances are permitted or even prescribed.
An example of this is the widow following the deceased spouse in death, which was normal practice in India for a long way into the previous century. The Second World War kamikaze actions by the Japanese is a well-known example. Just as the captain who refuses to desert his sinking ship. Such suicides were and sometimes still are, considered as honourable.
Some sects commit collective suicide at the command of their leader so as not to have to await the Day of Judgement.
The suicide of those who were too weak or old or whose existence maybe even formed a threat for the survival of the others was usual in some cultures. Until the last century, this was an accepted reason among the Eskimos in North America.