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Technology for Our Future? Exploring the Duty to Report and Processes of Subjectification Relating to Digitalized Suicide Prevention. INFORMATION 2020. [DOI: 10.3390/info11030170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Digital and networking technologies are increasingly used to predict who is at risk of attempting suicide. Such digitalized suicide prevention within and beyond mental health care raises ethical, social and legal issues for a range of actors involved. Here, I will draw on key literature to explore what issues (might) arise in relation to digitalized suicide prevention practices. I will start by reviewing some of the initiatives that are already implemented, and address some of the issues associated with these and with potential future initiatives. Rather than addressing the breadth of issues, however, I will then zoom in on two key issues: first, the duty of care and the duty to report, and how these two legal and professional standards may change within and through digitalized suicide prevention; and secondly a more philosophical exploration of how digitalized suicide prevention may alter human subjectivity. To end with the by now famous adagio, digitalized suicide prevention is neither good nor bad, nor is it neutral, and I will argue that we need sustained academic and social conversation about who can and should be involved in digitalized suicide prevention practices and, indeed, in what ways it can and should (not) happen.
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Barry L, Hobbins A, Kelleher D, Shah K, Devlin N, Goni JMR, O'Neill C. Euthanasia, religiosity and the valuation of health states: results from an Irish EQ5D5L valuation study and their implications for anchor values. Health Qual Life Outcomes 2018; 16:152. [PMID: 30064460 PMCID: PMC6069795 DOI: 10.1186/s12955-018-0985-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/25/2018] [Indexed: 12/05/2022] Open
Abstract
Background The Quality Adjusted Life Year influences the allocation of significant amounts of healthcare resources. Despite this surprisingly little research effort has been devoted to analysing how beliefs and attitudes to hastening death influence preferences for health states anchored at “dead” and “perfect health”. In this paper we examine how, inter alia, adherence to particular religious beliefs (religiosity) influences attitudes to euthanasia and how, inter alia, attitudes to euthanasia influences the willingness to assign worse than dead (WTD) values to health states using data collected as part of the Irish EQ5D5L valuation study. Methods A sample of 160 respondents each supplied 10 composite time trade-off valuations and information on religiosity and attitudes to euthanasia as part of a larger national survey. Data were analysed using a recursive bivariate probit model in which attitudes to euthanasia and willingness to assign WTD values were analysed jointly as functions of a range of covariates. Results Religiosity was a significant determinant of attitudes to euthanasia and attitudes to euthanasia were a significant determinant of the likelihood of assigning WTD values. A significant negative correlation in errors between the two probit models was observed indicative of support for the hypothesis of endogeneity between attitudes to euthanasia and readiness to assign WTD values. Conclusion In Ireland attitudes and beliefs play an important role in understanding health state preferences. Beyond Ireland this may have implications for: the construction of representative samples; understanding the values accorded health states and; the frequency with which value sets must be updated. Electronic supplementary material The online version of this article (10.1186/s12955-018-0985-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luke Barry
- J.E. Cairnes School of Business and Economics, NUI, Galway, Ireland
| | - Anna Hobbins
- Center for Public Health, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland
| | - Daniel Kelleher
- J.E. Cairnes School of Business and Economics, NUI, Galway, Ireland
| | | | | | | | - Ciaran O'Neill
- Center for Public Health, Queens University Belfast, Belfast, BT12 6BA, Northern Ireland.
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Religiosity and the Wish of Older Adults for Physician-Assisted Suicide. RELIGIONS 2018. [DOI: 10.3390/rel9030066] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Ponce Martinez C, Suratt CE, Chen DT. Cases That Haunt Us: The Rashomon Effect and Moral Distress on the Consult Service. PSYCHOSOMATICS 2017; 58:191-196. [DOI: 10.1016/j.psym.2016.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/15/2016] [Accepted: 09/16/2016] [Indexed: 10/21/2022]
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Pierre JM. Culturally sanctioned suicide: Euthanasia, seppuku, and terrorist martyrdom. World J Psychiatry 2015; 5:4-14. [PMID: 25815251 PMCID: PMC4369548 DOI: 10.5498/wjp.v5.i1.4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 12/21/2014] [Accepted: 01/19/2015] [Indexed: 02/05/2023] Open
Abstract
Suicide is one of the greatest concerns in psychiatric practice, with considerable efforts devoted to prevention. The psychiatric view of suicide tends to equate it with depression or other forms of mental illness. However, some forms of suicide occur independently of mental illness and within a framework of cultural sanctioning such that they aren’t regarded as suicide at all. Despite persistent taboos against suicide, euthanasia and physician-assisted suicide in the context of terminal illness is increasingly accepted as a way to preserve autonomy and dignity in the West. Seppuku, the ancient samurai ritual of suicide by self-stabbing, was long considered an honorable act of self-resolve such that despite the removal of cultural sanctioning, the rate of suicide in Japan remains high with suicide masquerading as seppuku still carried out both there and abroad. Suicide as an act of murder and terrorism is a practice currently popular with Islamic militants who regard it as martyrdom in the context of war. The absence of mental illness and the presence of cultural sanctioning do not mean that suicide should not be prevented. Culturally sanctioned suicide must be understood in terms of the specific motivations that underlie the choice of death over life. Efforts to prevent culturally sanctioned suicide must focus on alternatives to achieve similar ends and must ultimately be implemented within cultures to remove the sanctioning of self-destructive acts.
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Rosenfeld B, Pessin H, Marziliano A, Jacobson C, Sorger B, Abbey J, Olden M, Brescia R, Breitbart W. Does desire for hastened death change in terminally ill cancer patients? Soc Sci Med 2014; 111:35-40. [PMID: 24747154 DOI: 10.1016/j.socscimed.2014.03.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 03/01/2014] [Accepted: 03/26/2014] [Indexed: 01/30/2023]
Abstract
Understanding why some terminally ill patients may seek a hastened death (a construct referred to as "desire for hastened death" or DHD) is critical to understanding how to optimize quality of life during an individual's final weeks, months or even years of life. Although a number of predictor variables have emerged in past DHD research, there is a dearth of longitudinal research on how DHD changes over time and what factors might explain such changes. This study examined DHD over time in a sample of terminally ill cancer patients admitted to a palliative care hospital. A random sample of 128 patients completed the Schedule of Attitudes toward Hastened Death (SAHD) at two time points approximately 2-4 weeks apart participated. Patients were categorized into one of four trajectories based on their SAHD scores at both time points: low (low DHD at T1 and T2), rising (low DHD at T1 and high DHD at T2), falling (high DHD at T1 and low DHD at T2) and high (high DHD at T1 and T2). Among patients who were low at T1, several variables distinguished between those who developed DHD and those who did not: physical symptom distress, depression symptom severity, hopelessness, spiritual well-being, baseline DHD, and a history of mental health treatment. However, these same medical and clinical variables did not distinguish between the falling and high trajectories. Overall, there appears to be a relatively high frequency of change in DHD, even in the last weeks of life. Interventions designed to target patients who are exhibiting subthreshold DHD and feelings of hopelessness may reduce the occurrence of DHD emerging in this population.
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Affiliation(s)
- Barry Rosenfeld
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA.
| | - Hayley Pessin
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | | | | | | | | | - Megan Olden
- Weill-Cornell Medical College, New York, NY, USA
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Ho AO. Suicide: rationality and responsibility for life. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:141-7. [PMID: 24881162 PMCID: PMC4079241 DOI: 10.1177/070674371405900305] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Death by suicide is widely held as an undesirable outcome. Most Western countries place emphasis on patient autonomy, a concept of controversy in relation to suicide. This paper explores the tensions between patients' rights and many societies' overarching desire to prevent suicide, while clarifying the relations between mental disorders, mental capacity, and rational suicide. METHODS A literature search was conducted using search terms of suicide and ethics in the PubMed and LexisNexis Academic databases. Article titles and abstracts were reviewed and deemed relevant if the paper addressed topics of rational suicide, patient autonomy or rights, or responsibility for life. Further articles were found from reference lists and by suggestion from preliminary reviewers of this paper. RESULTS Suicidal behaviour in a person cannot be reliably predicted, yet various associations and organizations have developed standards of care for managing patients exhibiting suicidal behaviour. The responsibility for preventing suicide tends to be placed on the treating clinician. In cases where a person is capable of making treatment decisions--uninfluenced by any mental disorder--there is growing interest in the concept of rational suicide. CONCLUSIONS There is much debate about whether suicide can ever be rational. Designating suicide as an undesirable event that should never occur raises the debate of who is responsible for one's life and runs the risk of erroneously attributing blame for suicide. While upholding patient rights of autonomy in psychiatric care is laudable, cases of suicidality warrant a delicate consideration of clinical judgment, duty of care, and legal obligations.
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Affiliation(s)
- Angela Onkay Ho
- Psychiatry Resident, Department of Psychiatry, University of Toronto, Toronto, Ontario
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Halpin M. Accounts of suicidality in the Huntington disease community. OMEGA-JOURNAL OF DEATH AND DYING 2012; 65:317-34. [PMID: 23115895 DOI: 10.2190/om.65.4.e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Health professionals, researchers, and philosophers have debated extensively about suicide. Some believe suicides result from mental pathology, whereas others argue that individuals are capable of rational suicide. This debate is particularly poignant within illness communities, where individuals may be suffering from chronic and incurable conditions. This article engages with these issues by presenting the accounts of 20 individuals with Huntington disease (HD), a fatal degenerative condition, and 10 informal caregivers (e.g., spouses). Suicide is a leading cause of death amongst people with HD, with an incidence rate many times higher than the general population. In contrast to the majority of the academic literature on HD suicidality, study participants did not connect suicide with mental pathology. Instead, they perceived suicide as a response to the realities of living with HD, such as prolonged physiological degeneration and the need for long-term intensive health care. These findings are subsequently discussed in relation to the rational-pathological suicide binary.
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Affiliation(s)
- Michael Halpin
- Department of Sociology, University of Wisconsin-Madison, WI 53706-1393, USA.
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Campbell AT, Aulisio MP. The stigma of "mental" illness: end stage anorexia and treatment refusal. Int J Eat Disord 2012; 45:627-34. [PMID: 22331823 DOI: 10.1002/eat.22002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2011] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To answer the questions of whether psychiatric patients should ever be allowed to refuse life-sustaining treatment in favor of comfort care for a condition that is caused by a psychiatric disorder, and if so, under what conditions. METHOD Case discussion and normative ethical and legal analysis. RESULTS We argue that psychiatric patients should sometimes be allowed to refuse life-sustaining treatment in favor of comfort care for a condition that is caused by that psychiatric disorder and articulate the core considerations that should be taken into account when such a case arises. DISCUSSION We also suggest that unwillingness among many, especially mental health professionals, to consider seriously both of these questions risks perpetuating stigmatization of persons with psychiatric disorders, i.e., that the "mentally" ill should not be allowed to make significant decisions for themselves-a-a stigmatization that can result in persons with mental disorders both being prevented from exercising autonomous choice even when they are capable of it, and being denied good comfort care at the end of life--care which would be offered to patients with similarly life-threatening conditions that were not deemed to be the result of "mental" illness.
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Affiliation(s)
- Amy T Campbell
- Center for Bioethics and Humanities, SUNY Upstate Medical University and Syracuse University College of Law (courtesy), Syracuse, NY, USA.
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Abstract
Historically, medicine has been warned, “first, do no harm.” In contemporary practice, however, the emergency response has generally been to err on the side of action with resuscitation efforts. Typically, it is only later on when medical therapy is considered futile that treatment is withdrawn. In such circumstances, a do-not-resuscitate (DNR) order is typically enacted as a part of an advance directive. However, when such patients attempt suicide, the approach to their care becomes complicated. Is the DNR order valid in a suicidal patient? What is the role of patient autonomy? How should an ethics consultant advise? This case details the method by which such issues should be approached in the emergent care of patients who have DNR order and attempt suicide.
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Monforte-Royo C, Villavicencio-Chávez C, Tomás-Sábado J, Balaguer A. The wish to hasten death: a review of clinical studies. Psychooncology 2010; 20:795-804. [DOI: 10.1002/pon.1839] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 07/07/2010] [Accepted: 07/15/2010] [Indexed: 11/12/2022]
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