SUICIDE...IS IT IMMORAL?

A recent article by Ronald Pies, M.D. published in the February 2014, Vol XXXI, No2 issue of the Psychiatric Times was entitled: "Is Suicide Immoral?"  Dr. Pies reflects on his own and his families experience with the suicide of his uncle.  Dr. Pies describes the longstanding impact that the suicide had on his family and himself.  He describes the still ongoing questions about why and what they could have done to prevent it.  Dr. Pies, being a psychiatrist, is aware that the question of moral or immoral does not seem appropriate for his area of concern.  Instead, it is considered appropriate for psychiatrists to focus on detecting suicidal thoughts and assessing the risk that someone will act on these thoughts and then treating these at risk people in order to reduce the risk and help them to feel like life is worth living.  However, others have pointed out that a physician's work of healing and taking care of others is intrinsically about values and virtues.  So, it seems that a physician's committment to preserve and protect life puts in a position of taking a moral stance about suicide. 

So, what about the moral question regarding suicide.  One understanding is that suicide is about personal autonomy and every human beings right to decide their own fate regardgin living or dying.  However, Dr. Pies reports comments from Jennifer Hecht in her book, Stay: A History of Suicide and the Philosophies Against It, comments on the need to see suicide from it's impact on community and community values.  Ms. Hecht feels that suicide has a dramatic and damaging impact on the community. This would seem to indicate moral implications for the act of suicide.  Dr. Pies clarifies that he is not promoting castigating people who are suicidal or make suicide attempts as they are already most likely suffering from negative feelings about themselves.  However, he mentions the possibility of discussing the impact on the community with his patients who are suicidal. 

I believe that the recognition of the impact of suicide on communities [and families, of course] can help the understanding of why some people become suicidal.  I wonder if this isn't related to feelings of isolation from others, from their community.  Maybe a focus on helping people feel more connected to others would significantly reduce the incidence of suicides.  

It seems that we [human beings as well as other species] are meant to be in a community and connected with each other.  If this connection is broken, it is a problem for the person and for the community.  So, suicide is not only damaging to the community but also may represent a failure of the community to reach out to the individual.

Comments

[Ronald Pies MD]

Thanks very much for the nice discussion, Dr. Payton. As you might guess, my article generated a considerable amount of controversy, with some readers misconstruing my essay as "moral condemnation" of suicidal persons, "guilt tripping" them, etc. Of course, that was not at all my aim. I argued only that the issue of suicide has moral implications for psychiatrists--and indeed, for all of us--and that the adverse effects of suicide on those who remain behind are considerable. I agree with you, by the way, that a breach in the individual/community bond may be one relevant factor contributing to suicidal urges, in so far as social isolation or ostracism is concerned. I have a much more detailed and nuanced elaboration of this essay on Medscape, at this link: http://www.medscape.com/viewarticle/819565
Thanks again for commenting!

Best regards,
Ron Pies MD
SUNY Upstate Medical U., Syracuse NY
Tufts USM, Boston