Ethics and Suicide
Much has been written about the ethics of suicide (Heyd and Bloch, 1991), and a number of philosophers, as well as phy-sicians, have argued that suicide may be rational under some circumstances. Although US society no longer criminalizes at-tempted suicide, neither does it condone it. Thus, the strong current weight of ethical opinion, based on a commitment to the sanctity of life, is that usually psychiatrists ought to inter-vene to prevent or disrupt suicide attempts by patients. Further, according to this view, the psychiatrist’s duty to intervene may justify a breach of the ordinary obligation of confidentiality (see earlier discussion) and initiation of involuntary commit-ment and forced treatment proceedings because of the patient’s danger to self. Yet the obligation to respect the patient’s au-tonomy requires the psychiatrist to ask whether the intent to commit suicide in a particular case is sick and justifying – even mandating – intervention or whether it is a rational de-cision with which the physician has no ethical justification to interfere.
In a related vein, much debate has emerged in the past few years surrounding the ethical permissibility of physician-assisted suicide (Quill, 1991). Advocates for permissibility cite unbearable pain as a justification and submit that a regimen of procedural safeguards could adequately ensure against abuse (Quill, 1993). Among these safeguards would be the presence of a terminal or disabling condition from which there is no reasonable likelihood of recovery, the existence of an ongoing physician–patient rela-tionship, a patient capable of making decisions, and repeated and unequivocal requests by the patient for the physician’s assistance in hastening death.