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The last line of defense for some suicidal people is the dedicated mental health professional committed to helping their patient stay alive through profound darkness and pain. But a subversive movement within psychiatry, psychology, and social work holds that only “irrational” suicides should be prevented.  And for years, activists have sought to subvert the standards of psychiatric practice to permit mental health professionals to “permit” or “validate” some of their patients’ suicides.

Case in point, “Distinguishing Among Irrational Suicide and Other Forms of Hastened Death: Implications for Clinical Practice,” by Cavin P. Leeman, MD, FAPM, in the May-June Psychosomatics. From the article (no link):

Clearly, most suicide is irrational, and good clinical practice, as codified in the recent APA Practice Guideline for the Assessment and Treatment of Patients With Suicidal Behaviors, includes careful assessment of anyone known to have suicidal thoughts, plans, or behaviors. Yet, surprisingly, the Guideline does not even mention the possibility of rational suicide. Perhaps that is because of what has been referred to as psychiatry’s “reflexive antagonism to behaviors that hasten death.”

In contrast to APA’s official position, definitions of rational suicide have been appearing in the literature of psychiatry and mental health for at leas1 20 years. According to a 1986 article, in rational suicide “I) the individual possesses a realistic assessment of his situation; 2) the mental processes leading to his decision to commit suicide are unimpaired by psychological illness or severe emotional distress; and 3) the motivational bases of his decision would be understandable to the majority of uninvolved observers from his community or social group.”

In other words, if most people thought they would commit suicide under similar circumstances, let’s give the suicidal a going away party! Leeman then gives the example of “Mrs. S,” a suicidal woman with Huntington’s disease as an example of a suicide that should be permitted:
Indeed, if, after due diligence and reasonable postponement, extremely important steps that Dr. Kevorkian might not have insisted upon, Mrs. S is found to have decisional capacity and her decision is found to be deliberate, authentic, consistent with her long-held values, and not the result of mental illness, I believe that we are duty-bound to respect her right of self-determination, and not to interfere.” I would consider Mrs. S’s hastened death, under those circumstances, to be a relatively rare, but real, case of rational suicide.

Due diligence, shmu-diligence. Those are just words. In reality, once the concept was accepted, what constituted a “rational”  desire “to suicide”  (some of these advocates now use the word as a verb), would merely be in the eye of the beholder—as Oregon has already demonstrated. For example, if one psychiatrist said no, the patient could just go shrink shopping—as occurred in the Kate Cheney case—to find a mental health professional willing to give the A-Okay.  Indeed, as we saw in the Michael Freeland case, once suicide is validated, even people diagnosed as psychotic can still have access to suicide. (After he received a lethal prescription from a Compassion and Choices-referred doctor, a psychiatrist diagnosed Freeland as psychotic and recommended court supervision. But even though Freeland was delusional, he allowed the patient to keep a lethal prescription “safely at home.”)  And then there is the case of the woman who wanted assisted suicide in Oregon referred by the lethally prescribing doctor to a psychiatric “consultation,” which consisted of  a brief discussion by phone in the presence of her family who laughed at the questions being posed. The psychologist validated the suicide without ever meeting the patient.

Rational suicide is profound abandonment by definition. And it wouldn’t just affect patients whose own doctors validated their self destructive desires. It would also send out the societal message that the mental health professions believe suicide is a legitimate way out of one’s problems.  And that could lead to the deaths of a lot of people who never bothered to discuss their desires with a psychiatrist.

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