'Acceptable' for a doctor to support suicide as a choice?

TheBiologist

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I'm not talking about assisted suicide for sick people etc.

what do you think of doctors who support suicide as a "civil/natural right." Not that they would encourage it, just that they support an individual to make the choice for themselves

is this an okay opinion, or should one keep this opinion to themselves?
 

pyrrion89

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I support it. Sure many others do too. A person with decisional capacity should have the right to make decisions about their own bodies. The idea that some armchair spectator, who doesn't have to go through the pain or has no idea what it is like to be in that body, knows better and can restrict this person's choice... that's disgusting to me. Many states have legal assisted suicide, so it is certainly "acceptable" to believe in an idea that has enough mainstream support that it is legal in several states now.

I take the Hippocratic Oath to mean it is okay to perform euthanasia if it relieves suffering. To deny the request to someone who has a terminal prognosis and is in incurable, excruciating pain, is to do harm. To argue otherwise is just a level of overly concrete thinking---one ought to act to improve the patient's overall quality of life rather than stick to moral platitudes and absolutisms (i.e., it is never right to let someone die), in my opinion.

There is a distinction between doing the euthanasia yourself as the MD, vs giving the patient the means... but honestly it's the same, just seems like a technicality to me.

Obviously this is a very hot-button issue. On interviews I wouldn't bring it up unless you're asked... and even then I'd give a diplomatic answer (i.e., acknowledge the wisdom of both sides)
 
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Govols22

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I support it. Sure many others do too. A person with decisional capacity should have the right to make decisions about their own bodies. The idea that some armchair spectator, who doesn't have to go through the pain or has no idea what it is like to be in that body, knows better and can restrict this person's choice... that's disgusting to me. Many states have legal assisted suicide, so it is certainly "acceptable" to believe in an idea that has enough mainstream support that it is legal in several states now.

I take the Hippocratic Oath to mean it is okay to perform euthanasia if it relieves suffering. To deny the request to someone who has a terminal prognosis and is in incurable, excruciating pain, is to do harm. To argue otherwise is just a level of overly concrete thinking---one ought to act to improve the patient's overall quality of life rather than stick to moral platitudes and absolutisms (i.e., it is never right to let someone die), in my opinion.

There is a distinction between doing the euthanasia yourself as the MD, vs giving the patient the means... but honestly it's the same, just seems like a technicality to me.

Obviously this is a very hot-button issue. On interviews I wouldn't bring it up unless you're asked... and even then I'd give a diplomatic answer (i.e., acknowledge the wisdom of both sides)
The OP is not talking about assisted suicide.
He is talking about suicide in general.

The answer is absolutely no, it is not okay to support suicide.

If someone wants to commit suicide, they are clearly suffering from depression or other mental health issues and need help. Under no circumstances is it okay to say that people have the "right" to kill themselves. Assisted suicide is a seperate issue.
 

jm192

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I would absolutely not give a diplomatic answer.

This is America, and you can do whatever you want. But, wait for it, we're doctors. Not politicians or legislators. We don't care ab out the "rights."

Our job is to recognize those warning signs and save those people.

Suicide/depression is a disease process like anything else. If the same patient were walking around with chest pain for the last 3-4 months, are you going to support their decision to have a heart attack? Would you feel like a cruddy doctor knowing they were having chest pain, but never making that cardiology referral or arranging a stress test?

But if your patient is depressed and has the worst complication of depression--you're ok with that because they made a choice?? GTFO.

If someone you loved took their own life--you can love and forgive that person. It doesn't mean it's ok when your patient also does it because it was their choice. We lost that battle.

If you get in--you're there to save people--not to decide that their severe depression is "ok." Hell, we hospitalize people against their will so that they don't do just this.

If your patient commits suicide, and you're before a jury being asked why you missed the warning signs, "I support her decision" is going to go over great with the other attorney.
 

jm192

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Decline to answer. BTW, I believe I can see lots of political correctness here.
If you want a career that encourages you to express your "Suicide is ok" views, maybe Allopathic/osteopathic medicine isn't what you should be going into.

Again, the whole premise is that life is sacred.

There is nothing PC, some people are just showing their ignorance.

The second I determine a patient is high risk to harm themselves, I can place them under 72 hour hold. If you're having serious suicidal thoughs, you are default not able to make decisions.

So when you're an attending, and you're going to discharge your patient, they express they might kill themselves, do you say "I support your right to do so?"

Because you're an idiot if it's a yes.
 

begoood95

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Do I support suicide as a choice, as you've framed the question? No. From the physician's perspective, and with the philosophy behind medicine, suicide is not an option I would condone—especially if it's in the case of adolescents, of whom can virtually never make an "informed decision" about terminating their life indefinitely.

Now, is your question loaded, and does it bring up a relevant aside? Absolutely. @jm192, you make an interesting assertion, that "suicide/depression is a disease process like anything else." It's important to note, however, that we decide what is and what is not a disease; in other words, what you may consider a disease others might see as a blessing. (I'm not saying suicidal thoughts are a blessing.) At their core, disease and its diagnosis are a social construct—our biomedical, on occasion reductive, perspective is one of many, and it's useful to remember this. I say it's useful not because I think there is some better, more effective perspective or treatment methodology. Of course, modern medicine is unmatched in its ability to treat and cure disease.

It's useful to remember that modern medicine is a social construct because you will undoubtedly, at some point in your career, be in a situation where a patient disagrees with your (probably well-founded) opinion on their illness. In such a situation, we have to be sensitive to our patients' perspectives such that we may be able to convince them, or help them make a more informed decision on taking X medication. This isn't being PC, @UBLI-EINSTEIN, it's about recognizing that the best way to navigate through sensitive topics like this isn't by ignoring others' beliefs; if your goal is to keep a suicidal person from death, you had better not dismiss their opinion, regardless of what you think.

Anyways, here's a really good paper that gets into what I was talking about earlier, namely, the socially constructed nature of disease:
Naming and Framing: The Social Construction of Diagnosis and Illness.

Here's a book that's always referenced when people discuss the fact that different cultures often have
completely different opinions on disease:
The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures.
 

jm192

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There is no informed decision making or shared decision making on suicide. We really go that extra mile to make them listen on that one. :)
 
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TheBiologist

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If you want a career that encourages you to express your "Suicide is ok" views, maybe Allopathic/osteopathic medicine isn't what you should be going into.

Again, the whole premise is that life is sacred.

There is nothing PC, some people are just showing their ignorance.

The second I determine a patient is high risk to harm themselves, I can place them under 72 hour hold. If you're having serious suicidal thoughs, you are default not able to make decisions.

So when you're an attending, and you're going to discharge your patient, they express they might kill themselves, do you say "I support your right to do so?"

Because you're an idiot if it's a yes.
do you believe at all that this in in conflict with body autonomy and the right to refuse treatment? There are many people who refuse to be treated for curable diseases in the face of death because of personal reasons; why is a psychological disease any different?
 

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There is no informed decision making or shared decision making on suicide. We really go that extra mile to make them listen on that one. :)
Oh, I bet. Could you imagine someone going to a physician, discussing suicide, then having that physician say, "Yep, that's the best option for you. You've got my go-ahead!" That would never happen, and I hope that's not what my post suggested!

I just wanted to bring up an important aside, that not all diseases are viewed with apprehension, or as diseases at all.
 

begoood95

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Because it's a disease of your mind--which affects your decision making capacity. Is this a serious question?
Genuine question: so you're saying, as a disease of the mind, you can point to specific physiological markers that indicate said disease? Or, in other words, that there's some sort of neurological "dysfunction" in the brain of someone who is suicidal?
 
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jm192

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do you believe at all that this in in conflict with body autonomy and the right to refuse treatment? There are many people who refuse to be treated for curable diseases in the face of death because of personal reasons; why is a psychological disease any different?
I guess I should elaborate?

What's your current level? Pre-med? Med school? Resident? Attending?

If you're in the hospital, and you're of sound mind, you can refuse treatment.
If you're suicidal, you're not of sound mind. Those two do not coexist.

And any good malpractice attorney will damn sure let you know that. :)
 
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TheBiologist

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I guess I should elaborate?

What's your current level? Pre-med? Med school? Resident? Attending?

If you're in the hospital, and you're of sound mind, you can refuse treatment.
If you're suicidal, you're not of sound mind. Those two do not coexist.

And any good malpractice attorney will damn sure let you know that. :)
I'm pre-med

I guess I just have strong 'libertarian' views on stuff like this; I don't believe it's anyone's responsibility to force someone to do anything against their will unless they are harming other people - sound mind or not.

Keep in mind that I'm not saying I would break the rules/protocol as a physician and I certainly would do the best I could to get someone not to commit suicide
 

begoood95

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I guess I should elaborate?

What's your current level? Pre-med? Med school? Resident? Attending?

If you're in the hospital, and you're of sound mind, you can refuse treatment.
If you're suicidal, you're not of sound mind. Those two do not coexist.

And any good malpractice attorney will damn sure let you know that. :)
Oh, I think you answered my question. It's assumed a priori that someone who is suicidal is not of sound mind; thoughts of suicide preclude informed decision making.
 
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TheBiologist

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Oh, I think you answered my question. It's assumed a priori that someone who is suicidal is not of sound mind; thoughts of suicide preclude informed decision making.
but this - why is believing that witchcraft or magic will heal you considered informed decision making? I would say it's not lol yet we still have to honor their right to think magic will work if that's what a patient believes in
 

begoood95

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but this - why is believing that witchcraft or magic will heal you considered informed decision making? I would say it's not lol yet we still have to honor their right to think it will work if that's what a patient believes in
Believing witchcraft or magic will heal you isn't considered informed decision making, but it is a decision that, most of the time, doesn't result in any harm to the patient. So, for example, if your oncology patient wants to take some strange but harmless concoction of herbs, in addition to the standard chemotherapy, then it's fine; also, if they want to refuse the chemotherapy outright, and they are of sound mind and have been informed of the consequences and have explored all options, that is also their (unfortunate) prerogative.

We have to honor that right, yes, but there is no such "right" for suicide in medicine. And yes this is medicine, so, in general, political stances must be put aside.
 
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jm192

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I'm pre-med

I guess I just have strong 'libertarian' views on stuff like this; I don't believe it's anyone's responsibility to force someone to do anything against their will unless they are harming other people - sound mind or not.

Keep in mind that I'm not saying I would break the rules/protocol as a physician and I certainly would do the best I could to get someone not to commit suicide
I don't know a nice way to say "Reconsider those views."

You're signing up to save people. Your political views don't exist in a health care setting.
It's kindergarten level common sense: Are they going to die? You should probably stop that. And that isn't meant to be condescending, I'm just saying, you're overcomplicating it by all of the shared decision making/refuse treatment mumbo jumbo.

Is there a place for it? Sure. Learn to save people first. Learn not to save people when they're in a reasonable place to ask for it later.

Unfortunately in another 7-10 years, you'll be under a microscope. You shouldn't practice medicine in a way to avoid being sued. But FFS be conscious that it exists. If you knew someone was going to kill themselves, and your libertarian views precluded you from placing them in involuntary hold--you can just hand over a blank check. Maybe even your license?
 

jm192

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but this - why is believing that witchcraft or magic will heal you considered informed decision making? I would say it's not lol yet we still have to honor their right to think magic will work if that's what a patient believes in
We don't honor that, lol.

It's "informed" decision making. I tell you that the fish oil isn't as good as Lipitor.
I tell you that your peppermint oil and your chiropractor isn't going to fix your high blood pressure.
I show you the five consecutive elevated blood pressure readings.
I even go as far as to send the medicine to the pharmacy in case you change your mind.

But I can't make you pick it up.
 

Endoxifen

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Albert Camus said that suicide is the only true philosophical problem. While it's an interesting problem for a rational person, those who commit suicide are anything but. Like hard determinism, this position is ultimately self-defeating. So in short, no, a physician cannot and should not be in support of "rational suicide."

Edit: Except in the possible case of the terminally ill, there is no rationality in suicide. It's only escapism at it's worst and most complete.
 
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TheBiologist

TheBiologist

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Albert Camus said that suicide is the only true philosophical problem. While it's an interesting problem for a rational person, those who commit suicide are anything but. Like hard determinism, this position is ultimately self-defeating. So in short, no, a physician cannot and should not be in support of "rational suicide."

Edit: Except in the possible case of the terminally ill, there is no rationality in suicide. It's only escapism at it's worst and most complete.
did he write the myth of sisyphus? I think I've read something by him
 
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If you want a career that encourages you to express your "Suicide is ok" views, maybe Allopathic/osteopathic medicine isn't what you should be going into.

Again, the whole premise is that life is sacred.

There is nothing PC, some people are just showing their ignorance.

The second I determine a patient is high risk to harm themselves, I can place them under 72 hour hold. If you're having serious suicidal thoughs, you are default not able to make decisions.

So when you're an attending, and you're going to discharge your patient, they express they might kill themselves, do you say "I support your right to do so?"

Because you're an idiot if it's a yes.
I didn't say anything. Why you replied to me like that? You assumed I thought "suicide is ok without exceptions"?
Also, if my interpretation is right, you assumed people want to suicide must not be able to make decision by their own?

BTW, have you heard the Rosenhan experiment (1973)?
In the study, some volunteer pretended to have psychological issues initially, and later almost everyone had been admitted to hospital.
Even if later they started to behave normally, psychiatrists stigmatized all their behaviors and refuse to discharge them from the hospitals.
Didn't this study tell you that you can not open patients' brain and correctly know all their thoughts?
Finally everything is all your own interpretations and biases, and your decision may or may not be due to your arrogance.

Again, I said I decline to answer question. I simply said, "I believe I can see lots of political correctness here".
Did I say political correctness in this case must be wrong? No, I didn't say that. Plz don't put words on my mouth as I didn't say that.
 

jm192

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What is your argument? That mental health is stigmatized in America?

Because I'm not arguing that.

But if a patient tells you that they are suicidal, you DO in fact know their thoughts, no? Or maybe they're lying about being suicidal, and you hospitalize them for no good reason. But they're alive. And the worst you did was hospitalize someone who claimed to be suicidal. Oh the horror.

Do you know how many people I've hospitalized for chest pain who didn't really have chest pain?

Moreso, and I don't know your level of training, but most Doctors don't cite the Rosenhan experiment to convince me that we should let people kill themselves. That said, a suicidal patient doesn't have decision making capacity. Whether or not you agree with me, the country kind of does. Less people tend to die that way.

But again, what the hell is your point? You're telling me we should let them have decision making capacity?
If you care about people--it doesn't go over well when they die.
If you care about your license--it won't go over well with a jury.

"Well, he said he might kill himself, but Rosenhan showed us people could be faking to get into the hospital" GTFO.
 

CyrilFiggis

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Asking about thoughts of harming yourself or others is standard fare for any patient history/interview. Suicidal ideations are not "normal" activity and therefore must be looked at pathologically. Just like other diseases, these can be external or internal and it's our responsibility both ethically and legally to identify and treat the underlying etiology and/or the symptoms. If a patient is willing to admit to you that they are contemplating suicide, you should see that as a call for help.

@TheBiologist wait until you get into med school and you will have practical courses on medical ethics. You'll cover these cases as well as the plethora of variations and you'll find that even among the peers you agree with, your rationales will differ. You yourself have brought up two of Beauchamp and Childress' principles of biomedical ethics - the idea that suicide preserves autonomy and nonmaleficence. I can argue the other side of those same principles. Each case has to be treated as unique and none of us should have concrete thoughts. But what we should have as medical professionals are a set of guidelines to address these scenarios.

FWIW, medical students and doctors have a higher suicide rate than the general population. Among interns, depression rates are 40-70% higher in males and 100-130% in females. If you can look your peers and colleagues straight in the eye and say "it's ok, it's your natural right to do so." you have a fortitude I cannot muster.
 
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