Suicide: bad act or good intervention

This article develops a different perspective on the ethics of suicide, based on theoretical and clinical grounds. In terms of value theory, applying "good" or "bad" to the suicide act makes no sense. We need to shift our focus from a search for an ethical statement about suicide (e.g., "rational suicide") to the ethical justification for intervention based on the needs and interests of an affirming therapeutic profession. We choose to intervene because of values we hold about well-functioning, existence, potential for human life; and because as emphatic, social beings, we feel for others and are motivated by that feeling. This justification leads us to suggest a situational case-centered ethics for suicide intervention.     

Ethnocultural aspects of suicide in young people: a systematic literature review part 2: Risk factors, precipitating agents, and attitudes toward suicide

Different scholars have expressed the same regret for the lack of research on ethnocultural differences in youth suicide behavior and the need to conduct more comparative studies, necessary to develop culturally responsive prevention and intervention strategies. The authors reviewed 82 publications on youth suicide that have considered, to different degrees, the ethnicity/culture of the population studied. Part 1 of this article explored youth suicide rates and methods (SLTB, this issue), while the present paper examines risk and precipitating factors and attitudes toward suicide in young people from a cross-cultural perspective.     

Suicide intervention and non-ideal Kantian theory

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.     

Multidimensional Future Time Perspective as Moderators of the Relationships between Suicide Motivation,Preparation, and Its Predictors

The moderating impact of future time perspective (FTP) components on the relationships of hopelessness, depressive symptoms, and psychache with suicide motivation and preparation was investigated. In a sample of first year college students (N = 87) recruited on the basis of elevated suicide ideation and depressive symptoms, future thinking, optimism, and future connectedness attenuated the relationship of suicide motivation with depressive symptoms and hopelessness. Future thinking moderated the impact of depressive symptoms on suicide preparation. No moderating effects were found for psychache. This study demonstrates that FTP may buffer against the worst effects of salient suicide predictors among high‐risk students.     

Are Young Adults' Suicides Psychologically Different from Those of Other Adults? (The Shneidman Lecture)

ABSTRACT: This Shneidman Lecture addresses the question: Are young adults' suicides psychologically different from those of other adults? Eight clusters (or patterns) as possible predictors of suicide notes and, by implication, suicide are discussed to address this question. The eight clusters are as follows: unbearable psychological pain, interpersonal relations, rejection-aggression, inability to adjust, indirect expressions, identification-egression, ego, and cognitive constriction. Comparisons between young adults (aged 18–25) and other adults indicate that young adults' suicides do differ psychologically in a number of patterns, but that considerable commonalities exist across the adult life span. The presentation emphasizes that a life span developmental perspective is essential when one is attempting to understand the suicides of young adults. A number of genuine suicide notes of young adults are presented to illustrate, from an idiographic view, what it might have been like for these individuals in the last moments of their lives.     

On "intention" in the definition of suicide

The need for a comprehensive nomenclature in suicidology is now well recognized. In this paper the focus is on the issue of intention, which is identified as an essential aspect of any definition of suicide and suicidal behavior primarily because of its distinction from accidental behavior. The distinction between the retrospective perspective of motives versus the prospective perspective of intentions is highlighted, and I argue that the latter is more closely related to suicidal behavior. Finally, while motives and intentions tend to be used together in research, there is a need for sound research to clarify the roles of intentions in order to better understand suicide and attempted suicide.     

Marital status integration, suicide disapproval, and societal integration as explanations of marital status differences in female age-specific suicide rates

Sociological analyses of suicide have often neglected female suicide rates. Three competing explanations are tested to determine why the suicide rates of married women are, typically, lower than the suicide rates of women who are not married: (1) marital status integration, (2) societal integration, and (3) a nation's normative order about disapproval of suicide. Data refer to age and marital status-specific female suicide rates from 12 developed countries. The results provide the strongest support for the marital status integration theory and consistent support for the social integration perspective. There is also mixed support for the cultural disapproval of suicide hypothesis.     

Suicide: a 15-year review of the sociological literature. Part I: cultural and economic factors

Cultural and economic patterns from 130 sociological works on suicide from 1981 to 1995 are reviewed in this article. The traditional Durkheimian perspective on suicide was often questioned by research on the impact of the mass media, alcohol, class, modernization, religion, and politics. Major theoretical developments included the application of differential identification theory to Phillips's model of copycat suicide, the application of criminology's opportunity theory to suicide, and new explanations for the link between alcohol and the social suicide rate. Explanations are reviewed for the major new suicide trend: after half a century of convergence, male and female suicide rates are diverging. Finally, the review notes patterns of continued stability in suicide research findings in areas such as racial differences and economic strain.     

“自杀”：一个重要的伦理问题

自杀现已成为人类死亡十大原因之一 ,而且呈现出低龄化的趋势 ,越来越引起社会的关注。因而 ,从政治、经济、社会、疾病、文化等多视角来寻找自杀的外部原因 ,对探究这个重要的伦理问题是有益的。     

Similarities and Differences in Precipitating Events Between Black and Anglo Suicide Attempts

ABSTRACT: The rapid rise in suicide among young Blacks in America the past decade is of increasing concern to mental health practitioners and suicidologists. While there are some similarities among suicide attempts by Blacks and Whites, the pattern is that Black suicide attempters are distinctly more youthful. This exploratory study tests the hypothesis that the precipitating events for young Blacks who consider, plan, and attempt suicide is more likely to be “the loss or threatened loss of a love partner in the context of a negative value-orientation and intragroup pressures” than among Anglo suicide attempters. Specific strategies are recommended that use a family perspective for assisting Blacks who consider, plan and attempt suicide.     

An Evolutionary Account of Suicide Attacks: The Kamikaze Case

Explanations for suicide attacks abound. Yet the literature remains conceptually fragmented, with different authors focusing on different attitudes, incentive structures, values, psychological processes, strategic imperatives, and cultural, historical, and personal circumstances. Curiously, however, there have been few efforts to cast suicide bombing within the extensive evolutionary literature on human altruism—in which it clearly belongs. Neither have there been more than occasional efforts to mobilize the distinction between “proximate” and “ultimate” explanations, with most proposed explanations being proximate. Here we draw on content analyses from materials written by Japanese Kamikaze pilots to propose an evolvable cognitive algorithm—by hypothesis, species typical—that (1) specifies environmental circumstances under which such “heroic” behavior is likely; (2) is consistent at the proximate level with the Japanese data; and (3) that is not inconsistent with many of the diverse proximate attitudes, values, and psychological mechanisms that dominate discussions of contemporary suicide campaigns. The evolutionary perspective is not an alternative to most of the proximate explanations offered in discussions of contemporary cases but is, rather, a paradigm around which diverse proximate explanations can be organized.     

An ecological study of community-level correlates of suicide mortality rates in the Flemish region of Belgium, 1996-2005

An ecological study of age-standardized suicide rates in Belgian communities (1996-2005) was conducted using spatial regression techniques. Community characteristics were significantly related to suicide rates. There was mixed support for the social integration perspective: single person households were associated with higher suicide rates, while religious participation was unrelated and both immigration and the presence of non-European inhabitants had a negative impact. Deprivation had a positive relation with suicide. Population density had a negative influence on suicide rates. Areas with older populations had higher suicide risks than expected. A spatial contagion effect of neighboring communities was present for men. In the conclusion, hypotheses are presented on why an aging population could be associated with higher suicide rates in the community.     

The Moral Foundations of Equipoise and Its Role in International Research

This article reviews the Dutch societal debate on euthanasia/assisted suicide in dementia cases, specifically Alzheimer's disease. It discusses the ethical and practical dilemmas created by euthanasia requests in advance directives and the related inconsistencies in the Dutch legal regulations regarding euthanasia/assisted suicide. After an initial focus on euthanasia in advanced dementia, the actual debate concentrates on making euthanasia/assisted suicide possible in the very early stages of dementia. A review of the few known cases of assisted suicide of people with so-called early dementia raises the question why requests for euthanasia/assisted suicide from patients in the early stage of (late onset) Alzheimer's disease are virtually non-existent. In response to this question two explanations are offered. It is concluded that, in addition to a moral discussion on the limits of anticipatory choices, there is an urgent need to develop research into the patient's perspective with regard to medical treatment and care-giving in dementia, including end-of-life care.     

Equality, Justice, and Paternalism: Recentreing Debate about Physician-Assisted Suicide

abstract   Debate about physician-assisted suicide has typically focused on the values of autonomy and patient wellbeing. This is understandable, even reasonable, given the import-ance of these values in bioethics. However, these are not the only moral values there are. The purpose of this paper is to examine physician-assisted suicide on the basis of the values of equality and justice. In particular, I will evaluate two arguments that invoke equality, one in favour of physician-assisted suicide, one against it, and I will eventually argue that a convincing equality-based argument in support of physician-assisted suicide is available. I will conclude by showing how an equality-based perspective transforms some secondary features of debate about this issue.     

Rational suicide among the elderly.

Old age, in and of itself, should never need to be a cause for self-destruction. But suicide and assisted suicide carried out in the face of terminal illness causing unbearable suffering should be ethically and legally acceptable. This paper outlines a perspective on rational suicide--the final exit--among the elderly.     

Consistent Liberalism does not Require Active Euthanasia

I argue that ‘classical liberalism’ does not sanction any easy permissiveness about suicide and active euthanasia. I will use liberal arguments to argue that the distinction between active and passive euthanasia is real and that assisted suicide is, at the very least, deeply troubling when viewed from an authentic liberal perspective. The usual argument for active euthanasia is a utilitarian, not a liberal argument, as recent calls to eliminate the conscientious objection rights of doctors who refuse participation in such procedures plainly demonstrate. The paper focuses on arguments in the public sphere (such as those articulated by James Rachels).     

Collaborating to prevent suicide: a clinical-research perspective

It is argued that suicidality is essentially a relational phenomenon; the presence or absence of certain key relationships paradoxically can be both suicide causing and suicide preventive. The relational aspects of suicide are especially poignant in clinical work with suicidal patients. However, when suicidality is involved, there are a number of issues that can interfere with effective clinical practice. Fortunately, a new paradigm has begun to emerge in contemporary clinical suicidology, which objectifies suicidality and emphasizes the phenomenology of suicidal states. Moreover, from an increasingly empirical perspective, this approach is creating new and better ways to effectively assess and treat suicidal conditions.     

Suicide across the Life Span: Pathways to Prevention

As reflected in a recent series of highly visible suicide awareness and prevention activities, the call for a comprehensive suicide prevention strategy has never been stronger, nor more unified. Using the framework provided by the transactional model of human development, the author illustrates the central implications that a developmental perspective has for suicide prevention, emphasizing the need to consider multiple pathways to prevention, to place renewed emphasis on prevention strategies that have their impact earlier in the life course and earlier in the course of mental disorder, and to collaborate with prevention specialists and advocates in related fields.     

The cultural theory and model of suicide

A growing body of research has demonstrated important variations in the prevalence, nature, and correlates of suicide across ethnic and sexual minority groups. Despite these developments, existing clinical and research approaches to suicide assessment and prevention have not incorporated cultural variations in any systematic way. In addition, theoretical models of suicide have been largely devoid of cultural influence. The current report presents a comprehensive analysis of literature describing the relationship between cultural factors and suicide in three major ethnic groups (African Americans, Asian Americans, and Latinos) and LGBTQ¹ sexual minority groups. We utilized an inductive approach to synthesize this variegated body of research into four factors that account for 95% of existing culturally specific risk data: cultural sanctions, idioms of distress, minority stress, and social discord. These four cultural factors are then integrated into a theoretical framework: the Cultural Model of Suicide. Three theoretical principles emerge: (1) culture affects the types of stressors that lead to suicide; (2) cultural meanings associated with stressors and suicide affect the development of suicidal tendencies, one's threshold of tolerance for psychological pain, and subsequent suicidal acts; and (3) culture affects how suicidal thoughts, intent, plans, and attempts are expressed. The Cultural Model of Suicide provides an empirically guided cohesive approach that can inform culturally competent suicide assessment and prevention efforts in future research and clinical practice. Including both ethnic and sexual minorities in our investigations ensures advancement along a multiple identities perspective.