Category: Suicide

Abstract

This paper discusses the ethical issues related to the legalization or forbiddance of physician-assisted suicide (PAS). It identifies various stakeholders that are involved and presents their arguments in support of or in opposition to medically aid suicide. The author argues that patients should have the freedom of choice concerning his/her end-of-life decision and better if they die under the control of the professionals to avoid additional suffering. Next, it is stated that physicians facing ethical issues which forbid them to assist patients in dying should prioritize patients well-being over instructions. Finally, the author maintains that the legalization of PAS may not affect the development of alternative end-life care methods such as palliative care.

Introduction

The claims that physician-assisted suicide (PAS) should be legalized have intensified in recent years due to increasing public attention. The famous and controversial case of Brittany Maynards death of dignity has caused many people to contemplate this problem and decide what their ethical standpoint is. As a result, public opinion has divided into two opposing groups: those who support medical aid in dying and those who oppose it. The former party mostly consists of the common public; the latter generally includes professional medical associations. The fact that both sides are able to present valid justifications to strengthen their position proves that resolving this issue is not a trivial task and necessitates multifaceted analysis. Therefore, this paper, firstly, seeks to discuss different perspectives on ethical issues that arise around the topic of PAS, and, secondly, presents the arguments in support of Brittany Maynards decision to die with medical assistance.

The Definition of Physician-Assisted Suicide

According to Snyder Sulmasy & Mueller (2017), assisted suicide is physician participation in advising or providing, but not directly administering, the means or information enabling a person to intentionally end his or her life (p. 578). PAS, thus, refers to the aid that physicians provide to terminally ill patients who seek to die with dignity through prescription for a lethal dose of medication. That method differs from euthanasia, as the latter includes direct actions of the medical workers to end the suffering persons life. For instance, that can be lethal injections made by physicians.

States with Legal Protection of Physician-Assisted Suicide

Currently, eleven jurisdictions in the United States legally allow the practice of PAS. They include California, Colorado, District of Columbia, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington (Death with Dignity, 2021). Among them, ten of the administrative units have the laws that safeguard PAS, except Montana. On the other hand, the latters government found none of the existing laws to contradict or prohibit the right of the terminally ill patients to pursue or for physicians to provide medical aid in dying.

Ethical Issues Related to PAS

Either allowing PAS or forbidding it can raise ethical problems related to the rights and duties of various stakeholders. If PAS is not legal, then one of the basic human rights, namely, the freedom to choose, is violated. Conversely, the legalization of physician-assisted death contradicts the medical professionals ethical norms, which have existed since ancient times. It is argued that by agreeing to prescribe lethal doses of medication, physicians breach the Hippocratic Oath. Particularly, it contradicts the line that states: neither will I administer a poison to anybody when asked to do so nor will I suggest such a course (Ahlzen, 2020, p. 353). Therefore, medical workers are faced with an unpleasant decision between two options. If physicians refuse to assist terminally ill people, they doom the latter to suffering or trying risky self-administered or unprofessionally-assisted suicide attempts, which eventually can cause greater damage. Conversely, if doctors decide to aid patients in dying, they break the professional norms.

Moreover, legally allowed PAS raises concerns about the nature of a human being from a philosophical perspective. Some argue that seeking suicide may devalue the meaning of human existence when a person avoids pain and suffering by being unable to embrace them. Hence, a patient who seeks medical aid in death cheapens individuals lives (Butts & Rich, 2019). However, others criticize that notion as lacking compassion and being inhumane, especially when patients sufferings are unbearable.

The Authors Position on the Subject

Despite the complexity of the topic and the existence of equally valuable pros and cons of PAS, it is necessary for everyone concerned to solve the ethical dilemma. For that reason, the author of the paper intends to elaborate on the arguments supporting medical aid in dying. Firstly, it is argued that a patient has a personal right to choose how to end ones life. One who decides to die with dignity should be able to do that under the supervision of professionals instead of trying other methods of suicide, which may cause more harm to the person.

Secondly, Gallups nationwide poll shows that 72% of Americans support doctor-assisted suicide (Brenan, 2018). Therefore, it is evident that medical aid dying is not the caprice of a certain group of people but the will of the democratic society. Even though that desire may contradict the Hippocratic Oath, the doctors have to serve the well-being of the patients. Otherwise, the former is led by the instructions rather than by feelings of compassion towards patients. However, it is important to note that those medical workers who do not support PAS due to personal or religious views should not be forced to participate in the process.

Finally, although it is the belief that PAS can reduce the development of alternative methods such as palliative care, those views may be wrong. For instance, Oregon, where assist in dying exists more than two decades, is considered as one of the best jurisdictions in providing palliative care. Moreover, PAS may be used until other treatment approaches are not sufficiently developed to effectively reduce patients suffering.

The Position of American Nurses Association

Many official medical unions participated in the debate around PAS by publishing official positions, including American Nurses Association (ANA). The associations arguments against aid in dying include the sacredness of life, contradiction to professional values, and devaluation of human experience (American Nurses Association, 2019). ANA states that any participation of nurses in PAS is ethically and professionally prohibited but emphasizes that the latter should be able to have discussions concerning end-of-life with their patients. Medical assistants should encourage terminally ill people to choose palliative and hospice care. Furthermore, ANA contends that nurses should contemplate their ethical foundations about the issue and reach a clear understanding of their position on the matter.

Conclusion

In summary, this paper presented the analysis of the ethical questions that arise around the problem of PAS. Firstly, the definition of the term was provided, and eleven jurisdictions where PAS is legalized were identified. Secondly, the main ethical issues of medically assisted death were analyzed, presenting arguments of various stakeholders. Moreover, the authors personal arguments in favor of PAS were presented. They included the patients freedom of choice in the questions concerning his/her end-of-life and the necessity to concentrate on the patients well-being, not on the instructions that do not reflect public opinion. Additionally, the counterargument against the notion that the legalization of PAS may harm the development of alternative care methods was presented. Finally, the position of the American Nurses Association concerning the matter was analyzed.

References

Ahlzen, R. (2020). Suffering, authenticity, and physician assisted suicide. Medicine, Health Care and Philosophy, 23(3), 353-359.

American Nurses Association (2019). The nurses role when a patient requests medical aid in dying. Web.

Brenan M. (2018). Americans strong support for euthanasia persists. Gallup. Web.

Butts, J. B., & Rich, K. L. (2019). Nursing ethics: Across the curriculum and into practice (7^th ed.). Jones & Bartlett Learning.

Death with Dignity (2021). In your state. Web.

Snyder Sulmasy, L., & Mueller, P. S. (2017). Ethics and the legalization of physician-assisted suicide: An American College of Physicians position paper. Annals of Internal Medicine, 167(8), 576-578.

The Dynamic of Suicide

There are several suicide dynamics. The first dynamic is the precipitating condition. It entails the overwhelming of the suicidal individuals leaving them helpless and hopeless. The next dynamic of suicide is the search for a solution. Another dynamic is stimulus, which is an unendurable stress level or psychological pain. Lastly, there is a psychological need that entails being thwarted or frustrated.

The fear of the suicidal person is worse compared to death. The suicidal person feels hopeless and helpless, emotionally, due to the absence of coping mechanisms. The individual at the cognitive state thinks that the only solution is either the use of magic or suicide. The patient then engages in an internal conflict when he or she starts to battle with unbearable stress and survival. Under action, the patients seek to escape the overwhelming pain after which they start communicating their suicide intentions. The patient starts talking about suicide through the issuance of warnings and cues. However, the active suicidal period is limited and the patient can take long hours as a potentially suicidal person. He or she tends to have an ever-present attitude with opposing feelings like hate and love. The suicidal attempts build over time as it takes advantage of the failing attempts to stop it. The build-up duration is large enough for identification of the issue and its intervention (The Counseling Team International, 2015).

There are several psychological theories in the dynamic of suicide. The first one is the interpersonal-psychological theory. It argues that people who die due to suicide have the death desire and ability. The theory has two psychological states characteristics, which are feeling burdened and low socially alienated. The other psychological theory is behaviorism which argues that the acquisition of behavior is due to the individuals condition. The third one is the cognitive theory which argues about humans internal states and how they psychologically affect an individual. The other one is a developmental theory that gives a thinking framework about learning, human growth, and development. The next one is the humanist theory which argues about human beings goodness. Another one is the personality theory that focuses on why people behave the way they do. Lastly, there is social psychology theory that explains the social behavior and learning theory that focuses on the peoples learning process and how they acquire knowledge (Lange, Kruglanski, & Higgins, 2011).

Suicide and the Moral Dilemma

Suicide is the process of one intentionally taking his or her own life. Despair is the main cause of suicide and is attributed to mental disorders like drug abuse and depression. Stress factors play a role in suicides and may include interpersonal relationships and financial problems. However, the most common suicidal methods include hanging, use of firearms, and poisoning oneself (Liem et al., 2011).

The suicide moral dilemma can be experienced especially in assisted and unassisted suicide. Assisted suicide entails the professional assistance, given to the victim to conduct the activity. The person suffering is, therefore, assisted to die peacefully and indignity while still upholding the autonomy. However, the dilemma is if it is right to help one take his or her life or let it be a natural death (James & Gilliland, 2012).

Characteristics of Suicide Committers

Suicidal individuals have several distinct characteristics and feel helpless and hopeless when it comes to changing the situation. They are in dilemma of whether dying or living would be better. In addition, they are also depressed and have no or limited ability to cope with disappointment and stress (The Counseling Team International, 2015).

Similarities between Homicide and Suicide

Homicide and suicide have several similarities as per the act itself or the person doing the act. Suicide is a type of retroflexed or inverted homicide since one who kills himself must have intended to kill others. A common underlying and unconscious motivation are the major causes of both homicide and suicide that are lethal violence. In addition, the use of firearms and poison is a common aspect used by many victims. However, suicide and homicide are done in residential settings. The person who commits the homicide kills himself or herself after the act (Liem et al., 2011).

The Triage Assessment Form Use in Addressing Lethality

Crisis workers use the triage assessment form, as a tool to determine the suicide lethality of an individual. The worker should ask questions like, Are you thinking about killing yourself, &about killing someone else?, How?, When? and Where? (James & Gilliland, 2012). Empathy and collaboration must be applied by crisis workers in such sensitive questions. The questions should be close-ended, that is, seeking no or yes answers. However, probing should follow when getting a positive answer to determine the extent. The acronym SIMPLE STEPS can be used for effective and efficient use of Triage Assessment in the lethality case. The acronym represents Suicidal/ Homicidal, Ideation, Method, Pain, Loss, Troubleshooting, Emotions, Parents, and Stressors. The assessment provides acute crisis estimation as per the clients responses. In addition, it helps the worker know the possible causes of lethality in case the assessment is positive.

References

James, R. & Gilliland, B. (2012). Crisis Intervention Strategies. Boston, MA: Cengage Learning.

Lange, P. A. M. V., Kruglanski, A. W., & Higgins, E. T. (2011). Handbook of Theories of Social Psychology: Volume One. London: SAGE Publications.

Liem, M. et al. (2011). Homicide- Suicide and other Violent Deaths: An International Comparison. Forensic Science International, 207 (3), 70- 76.

The Counseling Team International (2015). Suicide Dynamics. Web.

Suicide is a widespread cause of death in the United States. According to the Centers for Disease Control and Prevention (2014), approximately 41149 people ended their lives in this way. Furthermore, the number of attempted suicides was even greater. In turn, it is essential to identify at-risk groups and recognize the typical symptoms exhibited by such individuals. This discussion can be of great use to many people. For instance, teachers should anticipate potential risks that can impact students. However, it is vital to remember that such tragedies can affect almost every family, and one should not overlook such threats.

Psychologists note that there are two age groups that are less resilient to the threat of suicide. In particular, they focus on the experiences of adolescents and people who are older than 50 (Rhoades & Murphy, 2015). Certainly, they have different motives for attempting suicide. For instance, teenagers can be affected by such issues as domestic abuse, divorce or bullying. Additionally, they exaggerate the significance of the problems that they encounter. In contrast, older people can struggle with such difficulties as loneliness, terminal illnesses, career problems, and so forth (Rhoades & Murphy, 2015). There are certain socio-economic characteristics that can distinguish people who try to kill themselves. As a rule, they are unemployed. Moreover, they do not have any close relatives. These individuals believe that they do not have to live for the sake of other people.

People should also recognize suicidal behaviors. For instance, much attention should be paid to mood swings. For example, at certain moments, these people can be in very high spirits. However, even a minor stressor can make them feel depressed. Moreover, they can even be reduced to tears. They also tend to increase the consumption of alcohol. However, they try to conceal such behaviors from other people. Apart from that, unprovoked aggression is widespread among such people. They can easily vent their spleen on their co-workers, relatives or fellow students. Thus, one should be knowledgeable about these behaviors to prevent the deaths of many people. Finally, such people often state that their lives are meaningless. Very often, they struggle with the sense of frustration.

Overall, one can take several steps to reduce the risks of suicide. In particular, parents should pay close attention to the emotional problems faced by their children. For instance, these difficulties can be caused by bullying. They should discuss these issues as soon as they notice the signs of depression or anxiety. Furthermore, school counselors should inform parents about possible suicidal behaviors. Apart from that, it is important to consider the role that can be played by employers. For instance, they enable workers to receive professional psychological counseling. Finally, community nurses and social workers can reduce the risk of such problems. They often work with old people who can be influenced by unemployment, poverty, and lack of social support.

Certainly, one cannot prevent every suicide; however, one can take various precautions that can minimize the risk of such events. In this case, counseling should be offered to those individuals who are in danger of killing themselves. There are certain attributes of people who are more likely to commit suicide. In particular, one should consider such aspects as the lack of relatives, unemployment, and poverty. These individuals are usually older than 50. The duty of community nurses and social workers is to help them overcome emotional problems.

Reference List

Rhoades, J., & Murphy, P. (2015). Clinical Consult to Psychiatric Nursing for Advanced Practice. New York, NY: Springer Publishing.

The Centers for Disease Control and Prevention. (2014). Suicide and Self-Inflicted Injury. Web.

Introduction

Suicide prevention is an idea often talked about to help people understand the resources available to prevent suicide. Over the years, the suicide rate has been slowly increasing, making it the third leading cause of death among young people. About 44,193 Americans die every year, and worldwide, the suicide rate has gone up by 60 percent in the last 50 years. Suicide affects family members and loved ones for years. The topic of suicide is not an easy idea to converse over. Suicide prevention is an important issue that should be discussed and recognized.

Understanding the Landscape of Suicide

Suicide prevention is saving one from committing suicide. Basing it on the patient’s risk factors, we use suicide prevention methods and treatments to help treat them. Suicide is taking one’s life intentionally. Committing suicide takes actions and planning when they are at their lowest point, with a little energy to think clearly and execute the plan. Anyone can be impacted by suicide. Usually, it affects people they are close with and their loved ones.

People with poor mental health and a history of suicidal behaviors are prone to contribute to this issue. The thoughts of suicide can touch anyone. Everyone around can solve this issue when they start contributing and understanding the issues. However, individually, only people with poor mental health can truly save themselves because they choose what they want to do with their life. Jobs like therapists are those who guide them away from their issues and help try to improve them as a person.

Suicide has been known to be one of the top 3 leading causes of death in America for young adults. It is the 10th leading cause of death in general. There is one suicide death for every estimated twenty-five suicide attempts. Each year, 800,000 people die from suicide, making it that’s double and twice the number of homicides. According to the article, psychiatric disorders, genetics, substance abuse, and family and social situations are the most frequently mentioned risk factors for suicide. It was also mentioned that the risk of suicide increases 20-fold for people with severe depressive illness and bipolar disorder (“Suicide and Suicide Prevention: Risk Factors and Treatment”).

Although there are other suicide risk factors, those are the more known ones for others to be aware of, especially depression and bipolar disorder. People with these factors are more likely prone to commit suicide. “The mental illnesses with the highest prevalence of suicide risk are major depressive disorder, bipolar disorder, schizophrenia, personality disorders, post-traumatic stress disorder, and eating disorders” (“Suicide and Suicide Prevention: Risk Factors and Treatment”). Suicide is also connected to other forms of injury and violence, such as violence, abuse, bullying, and sexual assaults.

The Power of Suicide Prevention

With suicide prevention, there are many benefits that come along with it. Suicide prevents comes with teaching us the knowledge and sight for warning signs among individuals. According to Johnson, a suicide program should include risk factors associated with suicide, resources for help, facts and statistics about suicide, and how to help yourself or a loved one. When it comes to saving lives, suicide prevention can reduce the number of deaths, allowing preservation among families and communities. Suicide prevention can improve an individual’s mental health, where prevention can identify people who are at risk of suicide and connect them with mental health treatment along with the support they need. By being able to reduce the suffering, people who struggle with the thoughts of suicide, as well as loved ones, don’t have to go through sadness and grief.

As there are benefits to suicide prevention, there are also potential challenges to suicide prevention. When trying to prevent suicide, there are limited resources. There might not be enough sources, such as low mental health professionals, to effectively address the needs of everyone at the risk of suicide. There may be stigma surrounding suicide and mental health issues, resulting in preventing people from seeking help and opening up to express their concerns (“Suicide Prevention”).

Due to stigma, people with mental illnesses may face discrimination, be bullied, be denied housing or employment opportunities, or become violent victims. Lastly, there is complexity around suicide prevention. According to “Suicide Prevention,” suicide is a rare outcome, requiring large studies to demonstrate an intervention effect. Because suicide is a complex issue with many potential contributing factors, such as mental illness, substance abuse, relationship problems, etc., it is difficult for a professional mental institute to identify and address all of the factors in a comprehensive way.

Conclusion

Suicide hotlines are available for people to call when they are thinking of doing it. Talking It gives the individual a chance to be heard and see that someone cares about them. The best way to help someone who is suicidal is to recognize the signs and reach out. They might express how they feel that they have no reason to keep going. Be there for those who are struggling, even if not a professional; talking to someone allows them to get the unhappy feeling out of their chest. Let them know things will get better in life, don’t end it, and be strong. Remind them that life still matters. Just give them a shoulder to lean on and an ear to listen to. The community should promote a healthy connection and protective environment, which can allow one to identify and support people at risk, follow up with them, help connect, and keep them safe. Suicide prevention educates and teaches coping and problem-solving skills.

References

1. “The Savage God: A Study of Suicide” by A. Alvarez
2. “The Virgin Suicides” by Jeffrey Eugenides
3. “Suicide: A Study in Sociology” by Émile Durkheim

Introduction

Suicide has become one of the alarming social problems of our time, affecting all our lives in one way or the other. It is a very common experience and everyday news in our society. Moreover, it is still considered a silent issue of discussion, with fewer or no efforts being made to prevent or stop this act.

Personal Narratives: Illuminating the Realities

Suicide is mainly the act of taking one’s own life. It is a complex topic involving copious factors and should not be defined by any single cause. Not all people who die by suicide have a mental illness, and not all people with a mental illness try to end their lives by suicide. People experiencing suicidal thoughts and feelings are suffering from numerous emotional pain. Most people who died by suicide typically had overwhelming feelings of hopelessness, depression, and helplessness. Actually, suicide is not a moral weakness or a character flaw. People going through suicide feel as though their pain is never-ending and that suicide is the only way to get rid of the suffering.

I am from Brahmanbaria, and I have heard or experienced a lot of suicidal cases. Many circumstances and factors contribute to this decision to end someone’s life. They can be Dowry, sexual abuse, depression, social pressure, mental illness, and many more reasons. I am including some incidents here-

Recently, a housewife allegedly committed suicide by setting herself afire at Sholakandi village in Brahmanbaria’s Sarail upazila. The victim was identified as Shima Rani Gope, 28, wife of Nantu Gope. Shima came to visit her father’s house in Sholakandi village a few days ago. And she set herself afire after pouring kerosene into the toilet of the house. Her charred body was recovered from the toilet after breaking open the door. The main reason behind her suicide was dowry. Her husband asked for money from her maternal house. As she was unable to ask for money and due to high depression because of her husband’s torture of her, she committed suicide.

Understanding Suicide: A Multifaceted Crisis

Another incident was when a girl who failed in the Secondary School Certificate (SSC) Examination allegedly committed suicide by taking poison at Mayrampur village in Bancharampur upazila of Brahmanbaria recently. She appeared in the examination from Dhariarchar Haji Omar Ali High School. She failed the SSC examination; she couldn’t handle that failure. Due to social pressure and emotional overflow, she committed suicide by taking poison.

And recently, a heartbreaking suicidal incident occurred near my house. And I have experienced this visibly. A young housewife and her newborn child died after the woman reportedly jumped off a hospital building after throwing down the child at Jail Road in Brahmanbaria town. The victims were Sima Akter, wife of a Bangladeshi expatriate living abroad, Monir Miah of village Ghatiar in Sadar upazila, and his three sons. Family sources said Sima was taken to Life Care Hospital after she went into labor on October 16. She gave birth to the boy through a cesarean section on the day and was scheduled to be discharged from the hospital on Friday morning.

Sima had an argument with her mother in the morning over paying the hospital bills, said companions of other patients in the ward. When her mother went outside after the brawl, the housewife allegedly took the baby and went to the rooftop of the six-story hospital building. She then threw down the child and jumped off the rooftop herself. Both of them died on the spot. The reason behind this suicide is presumed to be anxiety and depression. Post-pregnancy depression and anxiety as she was unable to pay the bills. Also, her husband was not near her as he lives abroad. This mental stress she could not handle, and due to rage, she committed suicide with her newborn baby. This incident had a great impact on people.

Prevention as Imperative: A Call to Action

The prevention of suicide is important not only to the victim but also to the survivors. One important thing to be kept in mind when dealing with suicide is that suicidal tendencies are always higher among the friends and relatives of a suicide victim. The grief, guilt, blame, shame, and feelings of helplessness experienced by survivors are also incalculable. Therefore, whenever a person, either directly or indirectly, threatens suicide, the listener should be accepting, caring, and supportive. Suicide is a failure of the creator’s will and plan. Many people want to end their lives because they cannot think of a good and satisfying reason to live.

We should take responsibility in this to give meaning to life. Allah has created each person with a specific purpose and designed a slot in the universe for which there is no substitute. We must teach every person to have the conviction that he/she is created or chosen to achieve His will and purpose. We must give answers, help, and comfort the agonized. Love and support can only support these grieving ones who are left alone with the question: If we make it possible to discover Allah’s purpose and design for each person day by day through prayer and meditation and constant fellowship with Allah, it will make life exciting and challenging. The love for life and the sense of urgency to do what is intended would be so overwhelming that there would not be any time to think of ending life.

Conclusion

As humans, it is true that we all must die one day. But the way we die also matters. Allah gave us this life, just one life, to enjoy it and take proper care of it. We are going to give our own account of how we use it one final day when we stand in front of the One who gave us. We have discussed suicide in my area in this paper, and the current growth rate is rising in a drastic way. There may obviously be more of it because some even consider people taking drugs or other intoxicants as indirectly committing suicide.

Now, in conclusion, I want to say that it is time we fight against it and tell the world that suicide is not an answer to life. There might be problems and suffering in life, but we have to face it. It is just a cowardly act to escape from suffering. But, on the other hand, if we endure the sufferings of life, the reward is always greater than what we actually imagine. Therefore, it is a great challenge for us to help someone in need, console someone depressed, and comfort them.

References

1. “It’s Kind of a Funny Story” by Ned Vizzini
2. “Stay: A History of Suicide and the Arguments Against It” by Jennifer Michael Hecht
3. “The Noonday Demon: An Atlas of Depression” by Andrew Solomon
4. “I Was Here” by Gayle Forman

Introduction

Did you know in 2017, 47,173 Americans died by suicide, being the 10th leading cause of death in the U.S. according to the “American Foundation for Suicide Prevention”? Many teens and adults have different reasons to take their own life, but suicide is never the answer. It only ends the victim’s pain, although the pain passes down to their loved ones. Teens and adults commit suicide for the following reasons: being bullied, depression, and living in an abusive household.

Bullying as a Silent Tormentor

Bullying over the years has changed. With all the advancement of technology, cyberbullying has become one of the worst types of bullying since a person can attack someone without physically being in front of them. For example, in Yucaipa, California, Rosalie Avila, a 13-year-old, hanged herself after years of bullying at school. According to “Bullied Teen Who Killed Herself Apologized for Being Ugly, Didn’t Want Any Photos at Funeral,” Rosalie Avila left a note that said, “…I love you, Mom. I’m sorry you’re gonna find me like this,” Rosalie’s father, Freddie Avila, tells PEOPLE. “Another note said, ‘Please, don’t post any pictures of me at my funeral.’ Those were her goodbye notes.”. Rosalie Avila was being made fun of because of her appearance and called names.

Rosalie believed everything they told her since it lowered her self-esteem. Furthermore, “…classmates circulated a video portraying what an ugly girl looked like and what a pretty girl looked like and used a picture of Rosalie to portray the ugly girl,” Claypool said. “The video was circulated throughout the school and online, going viral. In her suicide note, Rosalie apologized to her parents for being ugly.”. It is heartbreaking when a beautiful soul takes their own life because they can’t deal with the pain and thinks their only way out is to end their life. Rosalie Avila had a long life ahead of her, but sadly, she didn’t want to live her life anymore. When I think of bullies, what comes to mind is that it only happens in High School, Middle School, and Elementary, but sadly, that’s not true. Bullying can happen anywhere, at any time, and at any age.

Conclusion

For example, Rhian Collins, a 30-year-old nurse and mother of two kids, committed suicide after being bullied by her colleagues. The article “Nurse Killed Herself after being bullied at Work, Probe Finds” explains that Rhian, who worked at Cefn Coed Hospital in Swansea, Wales, hanged herself in her home. “She was having issues at work, investigating officer Sgt. Nia Lambley said, according to the report. She was being sworn at, bullied, and believed she was continually given the worst shifts on the ward. This led to her becoming obsessed with her appearance, and she would go to the gym four times a day.” Rhian Collins was having trouble with her colleagues since they made her work difficult and made her obsessed with her appearance.

References

1. “Stay: A History of Suicide and the Arguments Against It” by Jennifer Michael Hecht
2. “The Noonday Demon: An Atlas of Depression” by Andrew Solomon

Introduction

My overall response to this video is that it’s really informative and really digs into why people commit suicide and how it can be prevented. The video addresses the questions of: What kind of unhappiness leads to suicide? Many people face struggles in their lives, and as these struggles continue to grow, many people find that they have run out of coping mechanisms that can help them get through these struggles. It may only take one small act to send a person over the edge where they may contemplate or even commit suicide.

Understanding the Underlying Factors of Suicide

For some, it could be a breakup with a significant other, a loss of employment, an illness in the family, feeling unhappy or lonely, or feeling hopeless. For others, it might be because of failure and rejection they feel that they have caused. Suicide is a permanent solution to a temporary problem. Many of the people who commit suicide or try to attempt to commit suicide don’t want to die but just want the pain to stop. These people don’t see anything else; they just see the awful things happening to them. People who have suicidal thoughts are dealing with psychological pain, a bunch of negative emotions, loneliness, and guilt.

One type of suicide described in the documentary is egoistic suicide, which occurs when a person commits suicide as a result of not feeling like they belong to society; they struggle to find a reason to live. People who commit egoistic suicide have weak or very little social bonds to their society. Another type of suicide described in the documentary was altruistic suicide, which occurs when a person sacrifices one’s life to save or benefit others. Both examples were seen with the woman named Christine in the documentary. Christine, who is a middle-aged woman, tried to end her life by eating a huge amount of prescription drugs. She discusses her life in an emergency room.

Christine explains how unbearable life is for her. She feels her husband doesn’t love her, can’t bear the thought of being left alone, and believes her 12-year-old son is better off without her and with someone else. Another type of suicide described in the documentary was anomic suicide, which is linked to disillusionment and disappointment. It is a condition where social and moral norms are confused, unclear, or simply not present. This was seen in the documentary when a suicide hotline volunteer revealed what she had learned on the job. People don’t treat each other very well, she says. ‘It’s disillusioning.’ The last type of suicide described in the documentary was fatalistic suicide, which occurs in oppressive societies, causing people to die rather than live within their society.

An example of this was the 12-year-old boy who hanged himself. Many people do not believe that suicides affect others around them. When one commits such an act, everyone is affected, such as family members, friends, teammates, and even neighbors. The pain that the victim leaves behind for his loved ones is sometimes unbearable for them. Many of these people who have lost a loved one have mixed emotions. Some feel sadness, while others feel anger. I feel that one of the hardest things a family member has to do is clean up at the end of the day after their loved one has committed suicide. This can be emotional, hard, and unpleasant for family members. They do this while they are still trying to process what has happened, how it has happened, and why it happened.

Prevention Strategies and Their Importance

Preventing suicide emerges as a major theme in the documentary. The documentary provides information about preventing suicide and treating mental illness. It is believed that we can prevent suicides by learning and acting on early warning signs. Depression is the major cause of suicidal thoughts and ideas. After a while, people become worn down and become less happy and lonelier. Depression can affect anyone; it doesn’t matter if you are rich, poor, young, or old. It doesn’t look at your race, religion, or beliefs.

Depression is a medical condition that deals with the functioning of brain chemicals and emotions, and that is why it makes any person susceptible to it. Common causes for depression can include the death of a loved one or someone close, divorce, or loss of a home or job. Depression leads to people having pain, which causes them to have a displeasure from something that is important to the person suffering.

Suicide intervention is another theme in the documentary. The director of Suicide Intervention Training plays a really emotional 911 tape-recorded when a young girl finds her dead brother, who has shot himself in the head. He’s trying to prepare his Police Department’s 911 operators for the emotion and the horror they will face should they ever receive such a call. The director of the documentary takes his camera to different suicide intervention centers to show how many professionals are being prepared to prevent someone from committing suicide. Postvention is a response to help the healing of individuals from grief and stress and prevent suicide in people who have been exposed to suicide and are at high risk.

Conclusion

Examples of this are given throughout the documentary, but the one that stood out to me was Christine. I believe that the more people are educated about suicide, the warning signs, and how to prevent suicide, the more it might decrease the number of suicides in America.

References

1. “The Suicidal Mind” by Edwin S. Shneidman
2. “My Lovely Wife in the Psych Ward: A Memoir” by Mark Lukach
3. “Reasons to Stay Alive” by Matt Haig
4. “Suicide: A Study in Sociology” by Emile Durkheim

Introduction

Suicide is one of the major leading causes of death for young adolescents ages 15-24. Somewhere in America, a child is in their room having suicidal thoughts. They are overthinking if it is worth being alive or if anyone cares if they are gone. Day by day, the thought just keeps spiraling in their head until one night, they finally attempt to disappear. Some succeed in carrying out their plan, but those who do not are able to get a second chance to look for help. Children are dealing with depression and suicidal ideation alone because they believe there is no one they can count on.

Informing Students

Most of the time, parents do not even know their children are going through such things as depression, anxiety, or suicidal thoughts. Parents and schools should work together to provide a safe environment where teenagers feel comfortable finding the resources they need to talk about their issues. Both high schools and middle schools should implement suicide prevention programs because these programs help inform students about the issue, provide counseling for students who are at risk for suicide and can decrease suicide rates among teenagers.

Suicide among young adolescents is the most severe health problem faced in the United States. Mental health is overlooked by many parents; most of the time, parents do not know when their children are in distress. Throughout the years, these rates have only been increasing. As of 2017, young adults ages 15-24 had a suicide rate of 14.46 (AFSP). Parents often feel uncomfortable talking about suicide or mental illness and tend to avoid the subject. Organizations have strived to place suicide prevention programs in schools as a resource for students. According to Elizabeth Schilling, affiliated with the American Public Health Association, The SOS Suicide Prevention Program is being held in a few high schools across the United States and has seen a decrease in suicide attempts. Another prevention program, Stop a Suicide Today, is provided at schools and has experienced success in reducing suicide attempts.

The reason for these programs is to help inform, observe, and identify students with warning signs of depression or suicidal behavior. Self-administered questionnaires are completed by students to further evaluate students. Many young adolescents feel like they have no support or feel afraid to reach out for reasons such as thinking adults will not believe them or possibly judge them for the situation. (Schilling). Providing these prevention programs in schools is an informative and interactive opportunity for students and teachers to raise awareness of suicide and depression. It will help start a conversation in the classroom about mental illness and the stigma surrounding suicide. Students’ knowledge is increased, and they are presented with resources available to them to get help for themselves or others. As a parent, family members, teachers, school counselors/administrators, etc., we as a whole community need to step up and cooperate in supporting these young adolescents, fearing to reach out for help.

Providing suicide prevention programs in both high schools and middle schools would help inform students about the issue. Jessica Portner, a publisher from Education Week, suggests that just like schools have effective plans for fire, tornado, or lockdown drills, they should have one for suicide prevention. When it comes to situations like suicide, schools are unprepared to deal with it (Portner). By getting informed, these students can also be a part of helping others they may know are going through suicidal ideations. This idea is also a way for students to understand what others may be feeling because we never truly see what is going on through one’s mind. Some might show signs, for example, a lack of interest in events or hobbies, sleeping more often, or distancing themselves from friends and family.

Counseling for At-Risk Students

In some cases, they hide from what they may be going through. They might act like they are living their best life and have nothing to worry about, but in reality, it might be the complete opposite. Recently, an acquaintance from high school tragically committed suicide. Everyone described him as a happy, loving, hardworking, caring, funny, responsible, and extraordinary person. Someone whom you would never think would do such a thing, but that day, he left a distressful message and never returned home. He was later found dead, and everyone questioned why this tragedy occurred.

You must always check up on friends because you never know what they could truly be feeling. Bill Bernat, a Ted Talk speaker, expresses that sometimes the best way to connect with a friend who is depressed is simply by being there to distract them from their own thoughts. It is tough not knowing what to say to a close friend, but that is why being informed is helpful for situations like these. Having a friend by your side who makes an effort to keep you distracted simply by going shopping, playing sports, or anything you might like are the friends that may help you recover without even trying (Bernat). Not only can friends do this, but so can teachers.

By creating a trustworthy relationship with a student who is going through hardships, the student will feel comfortable enough to confide in the teacher. Sometimes, these young adults cannot confide in a parent because the quality of the relationship contributes to their depression. The closest adult they can confide in is teachers, and that is why teachers should also engage in suicide prevention programs. In Jonathan Singer’s article, a social work professor states that if school staff obtained training in suicide counseling, they would be able to help inform school social workers. It is a lot of responsibility to take as a teacher, but if they are willing to help, it will save many children who are at risk of committing suicide.

Decreasing Suicide Rates

Through these programs’ students are not only being informed, they are also being provided with counseling for those at risk of suicide. Many are too afraid to reach out for counseling, but with these programs, they will either be helped or encouraged to reach for more resources. Hannah Nieskens and Melissa Robbins acknowledge that it takes an immense amount of effort to make suicide prevention a priority in schools. According to Research done at a high school, 31% of students have felt sad or hopeless almost every day for two weeks or more in a row. Over 20% have sincerely considered attempting suicide, and 10% have attempted suicide (Education Week). Providing a Multi-Tiered System of Support would help identify and support students who are struggling emotionally, academically, socially, or behaviorally (Nieskens & Robbins).

Making teachers’ students’ mental health a responsibility will ensure that they have the amount of support needed to be successful emotionally and academically. Some teenagers avoid speaking about it with a friend because they feel like it would be a burden on them, and they would also not know how to deal with it either. This is another reason teenagers tend to keep everything to themselves, believing they could handle it. Until one day, it becomes overwhelming to the point they have had enough. A young teenager who attempted suicide, Leanne Coiled, states, “I did not want to die…but I was so sick of the routine that I was in. I was kind of in a choice of do I continue to feel how I feel or just end this and not worry about it anymore.”

As every problem begins to pile up, it is something you would rather not deal with any longer. Ivy Kwong, the therapist, analyzes the Netflix series 13 Reasons Why. Hannah Baker, the main character, reaches out to someone for help: her school counselor. Kwong mentions that the counselor “does not pick up on her signs of depression and instead asks her all sorts of victim blaming and shaming questions. The one adult Hannah reaches out to for help lets her down.” This is a perfect example of why many students are afraid of reaching out; they believe they will not get the support they need. In some cases, counselors may not know how to respond, but having the resources available for any issues that may arise is helpful. All middle schools and high schools should find a way to address how to improve students’ mental health and prevent suicide. It is important for teachers to have resources available in hand to prevent any tragedies.

Breaking the Stigma

Decreasing these suicide rates takes an immense amount of effort and responsibility, but if we do not start to make a change, teen suicide will continue to rise. According to Michael Lindsey, director of Research at the Silver School of Social Work, a study has shown that suicidal behavior is occurring due to some children lacking the necessary resources. While being a part of a team that analyzed data documenting suicidal behavior, Lindsey “suggests that continued concern and attention regarding suicidal behavior among high school youth is warranted.”

In an article by Aaron E. Carroll, he claims that it was the first time in more than 20 years there were more teenagers who died from suicide than homicides in 2011. He goes on to state, “These trends have been known for years. Our response to them has not adequately acknowledged their progression.” As a society, we can support by providing a safer and supportive environment for teenagers, such as at school and at home. Letting those friends or family relatives who are at risk of suicide know that they are not alone and reassuring them that they are worth living. I’m checking up on them here and there to limit isolation.

If you have a friend who you believe is showing signs or signals of suicide, it is best not to hesitate to ask them in a way where they are calm and open to having that conversation. Having patience with them is important because it is something they are not comfortable speaking about. Stephanie Doupnik, a pediatrician and child health advocate, was inspired to understand what it is like for adolescents who seek emergency treatment to prevent suicide (Vox). She and her colleagues conducted a research study to perceive adolescents’ experiences to improve care for them. Many appreciate having someone trustworthy to talk to because all these teenagers want to feel better.

Sometimes, having a supportive professional allows adolescents to feel relieved and well-cared for. Even if it is simply being a supportive friend, family, teacher, etc., they can help improve individuals’ journey toward feeling better. Shayda, a suicide survivor, said, “You can’t read depression on the outside based on how a person is looking. You can smile and feel depressed. You can smile and still feel like you want to die.” We may not know what everyone is going through, but instead, we should not judge a person who might be on the edge of committing something horrific. The least we could do is give them a simple smile or sit down and listen to them. By doing so, we could help make a difference.

Many films, books, and television shows have received backlash for exposing young adults to suicide. Organizations like the American Foundation for Suicide Prevention and Christine Moutier, director of The Parents Television Council, who supervises entertainment media, were against the Netflix series 13 Reasons Why. They both demanded Netflix to take down the show when it was released in March 2017 for displaying the graphic suicide scene of Hannah Baker. The self-inflicted wounds were too graphic for certain viewers, but it is no different from gruesome movies and violent video games. A recent study examined the series on the apparent effect of internet searches on suicide. Brian Yorkey, the show’s creator, states that the show was created “to tell a story that would help young viewers feel seen and heard and encourage empathy in all who viewed it.”

Although the film was made to help viewers, a positive and negative outcome came to be. As hoped, there were searches like “suicide hotline,” “suicide prevention,” and “teen suicide.” But there were also searches like “how to commit suicide” and “how to kill yourself” (The New York Times). A study’s author wrote, “It has increased suicidal awareness while unintentionally increasing suicidal ideation” (The Washington Post). It was meant to be a raw and graphic series because it is the crucial truth about what people go through, and it is hard for adults to accept that there are young people dying because of suicide and depression. Many teenagers have actually found the series 13 Reasons Why as an encouragement to start a conversation and reach out for help. Overall, this series has had its ups and downs, but it has definitely opened an opportunity to begin a conversation with young adolescents about difficult issues like suicide and depression.

Encouraging Open Conversations

Some parents are against schools taking advantage of teaching their children about suicide and mental health. According to Jessica Portner, many parents believe situations like suicide or mental health are family matters discussions and not their responsibility to teach them. They believe schools should focus on academic purposes and interfere with their parenting. Parents tend to avoid the topic of suicide or mental illness because some may think it is not an important issue for their children to know; they would rather not speak of an overwhelming subject or are simply not ready to cope with the acceptance of their child having mental health problems (Portner).

This is why young adults are afraid of speaking to their parents about their situation because parents tend to believe they are not dealing with anything and are mentally okay. It is common for parents to sense the need to protect their children from harm. Who would want their children to suffer from mental illness? Sometimes, trying to protect your children is not the best idea because it can turn out to worsen the situation. Parents want to believe their children are always healthy and have no distress, even at such a young age as 15. They might also confuse a teenager’s change of character as just a phase, or they will get over it.

However, ignoring the truth will only lead to a point where you can no longer ignore it. Leading parents to say, “I had no idea; I never thought they would do that.” This only makes parents feel disappointed and start blaming themselves for noticing when it was too late, wishing their kid would have just said something. The best you can do for your children is to inform and observe them for any symptoms. It does not hurt to ask your kid if they are okay or if something is wrong. You want your kids to feel like they can trust you and count on you for support. Not only will it be easier to prevent a tragedy, but both the parent and child will be well informed of the support systems available.

Conclusion

The rates of teen suicides and suicide attempts are on the rise and will continue to increase if we as a society do not begin to make an effort to prevent these tragedies. Many people fear talking about mental illness and suicide when it should be our job to remove its stigma. If we continue to avoid this conversation, it will only endure a worse outcome. Suicide has become the most concerning health problem faced in the United States. Providing prevention programs in both middle schools and high schools will benefit students by providing knowledge about depression and suicide. Students will learn how to seek help for themselves or a friend and how to overcome obstacles preventing them from seeking help. Our community can do so much simply by cooperating in guiding these young adults to feel better. If we do this, we can save a life and make them feel cared for instead of having them feel hopeless in their room and having suicidal thoughts.

References

1. American Foundation for Suicide Prevention (AFSP) URL: https://afsp.org/suicide-statistics/
2. Schilling, E.(American Public Health Association). Suicide Prevention Programs in Schools: A Policy Brief. [PDF Document] URL: https://www.apha.org/~/media/files/pdf/factsheets/suicide%20prevention%20school%20policy%20brief.ashx
3. Portner, J. (Education Week). Schools Struggle to Find Best Ways to Address Students’ Mental Health. [Website] URL: https://www.edweek.org/leadership/schools-struggle-to-find-best-ways-to-address-students-mental-health/2006/02
4. Bernat, B. (TED Talk). How Conversations Can Save Lives. [TED Talk Video URL: https://www.ted.com/talks/bill_bernat_how_conversations_can_save_lives
5. Nieskens, H. & Robbins, M. Creating a Safe Space: What Schools Can Do to Help Prevent Teen Suicide. [Website] URL: https://www.edweek.org/leadership/creating-a-safe-space-what-schools-can-do-to-help-prevent-teen-suicide/2021/08

The prevalence of suicide in Australia is a growing concern. In 2017 the number of lives lost through intentional self-harm was 3128. This is an increase of 9.1% from the previous year (‘Causes of Death, Australia, 2017’, 2019). The Australian State and Federal Governments have acknowledged this crisis in recent years. In 2016, the Victorian Government released a 10-year plan to reduce suicide rates called the ‘Victorian Suicide Prevention Framework 2016- 2025’. This aims at halving the current suicide rate by half (Department of Health & Human Services, 2016).

There are various policy documents that have been released that look what can and should be done to reduce suicide rate, as well as a report evaluating what measures Australia has already taken. According to the World Health Organisation, suicide is defined as “an act deliberately initiated and performed by a person in the full knowledge or expectation of its fatal outcome” (World Health Organisation, 2001, p.37 ). In Australia for a death to be deemed a suicide, a colonial enquiry must determine that the death has resulted from the deliberate act from the deceased with the intentional knowledge of ending his or her own life. Intentional self-harm is different to suicide as it does not include the suicidal intent when causing deliberate harm to the body (Suicide Prevention Australia, 2014).

Determining the true statistics of suicide poses some limitations. Many suicides are completed alone which leads to difficulty in determining whether the death was intentional, accidental or even a homicide. The Australian Bureau of Statistics data for 2017, had the (age- specific) suicide rate at 12.7 per 100,000. This is an increase from 11.7 in 2016 (‘Causes of Death, Australia, 2017’, 2019).

For every individual who dies through suicide, it is estimated that nearly 30 people have likewise attempted to end their life (‘Statistics on Suicide in Australia’, 2019). The death of someone through suicide causes a ripple effect into the community. A life lost through suicide is a preventable death. Some populations in the community are more vulnerable and the reasons (or culmination of reasons) people choose suicide can vary from individual to individual. (National Suicide Prevention Project Reference Group, 2019).

In preventing suicide, we must look at these factors and help these vulnerable individuals contemplating suicide to get the right support. Health professionals have the potential to effect change in a greater arena and the role of Mental Health Nurses will continue to grow. Mental Health Nurses have the potential to reducing the suicide rate by implementing change at ward and/ or community level whist also at a policy level. Nurses are often at the front-line when delivering care. It is here that mental health nurses have the ability to make a genuine impact on assisting in reducing the suicide rate. Ensuring mental health nurses are appropriately trained to deliver patient centred care, ensures that people who have contemplated suicide receive the best treatment, therapy and resources to move forward in their lives.

The stigma associated with suicide is still prevalent in todays society. Granted mental health is a more common topic in 2019, there are still people every day who do not seek help and those who do not support the vulnerable due to the stigma associated with suicide. A suicide has been estimated to greatly impact on at least 10 people (Erlich et al., 2017). The people bereaved by suicide are more vulnerable to ongoing mental health issues and even at risk of suicide themselves (‘Standards and Guidelines for Suicide Bereavement Support Groups’, 2009). The process of postvention ensures this vulnerable group can receive the resources and/ or treatment for their situation.

Mental Health nurses have the ability to decrease the suicide rate. This can be achieved through ensuring that nurses are able to provide appropriate clinical care and interventions for individuals who have expressed interest in or attempted suicide. It is imperative that nurses are trained appropriately and maintain the skills to be able to assist in reducing the suicide rate. When nurses have developed competent clinical skills they can deliver more efficient clinical care. It is additionally important for nurses to examine their own personal attitudes and beliefs regarding intentional self-harm and suicide. When nurses can deliver more effective assessments and treatments they are able to provide quality patient care which will lead to better patient outcomes (Manuel, Crowe, Inder & Henaghan, 2017).

In 2014 the World Health Organisation released ‘Preventing Suicide: A global imperative’ which highlighted 11 elements of a system-based approach to suicide prevention. Elements ‘Training and Education’ and ‘Treatment’ acknowledge the importance of education and training for nurses and other health professionals in providing the necessary care for consumers (World Health Organisation, 2014). The World Health Organisation report has been adapted throughout the world as national strategy or policy for suicide prevention, highlighting the importance of these two elements.

The importance of having a skilled and compassionate workforce of nurses and other health professionals’ will assist in reducing the suicide rate.

There are currently various different trainings available to nurses and other health professionals in Australia. This includes Applied Suicide Intervention Skills Training, Mental Health First Aid and Advanced Training in Suicide Prevention by the Black Dog Institute (National Suicide Prevention Project Reference Group, 2019). ASIST is Applied Suicide Intervention Skills Training that started in Canada over 30 years ago but has been prominent in Australia since 1995 (‘ASIST » LivingWorks Education Australia’, 2019). It is widely used by health care providers but can be completed by anyone over the age of sixteen. It is a two-day workshop that teaches the participants to recognise when someone may be at risk of suicide and working with them to create a plan that will support their immediate safety. ASIST trains people to recognise early warning signs of suicidal behaviour and intervene early. In an evaluation of the ASIST program, the national crisis hotline Lifeline monitored 1507 calls from individuals contemplating suicide. Data denoted that individuals who spoke to ASIST trained counsellors reported feeling less overwhelmed, depressed and stressed (Gould, Cross, Pisani, Munfakh & Kleinman, 2013). Adequately training nurses and other health professionals in suicide prevention has the potential to yield similar results as the ASIST trained counsellors and assist in reducing the Australian suicide rate. ASIST is currently being piloted in Aboriginal in Torres Strait Islander Communities, empowering Elders and community members (National Suicide Prevention Project Reference Group, 2019).

In the Australian ‘National Suicide Prevention Strategy’ for 2020 to 2025, the proposed priority enabler of ‘building and maintaining a competent, compassionate workforce’ is relevant (National Suicide Prevention Project Reference Group, 2019). This proposed area hopes to support health professionals to provide compassionate and effective care for people with suicidal behaviours. While it is noted that mental health nurses with proficient skills and knowledge will lead to better care, treatment and outcomes for suicidal patients it is also essential that nurses evaluate their own personal feeling and beliefs regarding suicide and intentional self-harm (Chan, Chien & Tso, 2009).

The Australian Nursing and Midwifery Boards’ ‘code of conduct for nurses’ outlines the principles and standards expected of all nurses, including the professional responsibility to ensure the interests of the people are their first concern (Code of Conduct for Nurses, 2018).

It is essential that mental health nurses and all other health professionals acknowledge when their own beliefs may compete with the best interests of their patient and ensure their views don’t interfere with their patients receiving the best patient centred care. The potential that mental health nurses have in implementing care and treatment for consumers who have attempted suicide to reducing the rate is limitless. Mental Health Nurses have more training then general practice health professionals who usually have less specific training and knowledge to help recognise the symptoms in consumers who present to services.

Continuing to reduce the stigma associated with seeking mental health help and talking about suicide can help lowering the current suicide rate. There has been a vast increase in the amount of research surrounding suicide and prevention in the past ten years. Despite this, stigma of seeking mental health help is still prevalent in today’s society. This stigma results in people feeling alone and can even act as deterrent for people to support the people vulnerable to suicide in their lives. Mental Health Nurses can advocate for change in various different ways.

Through promotion of mental health and suicide awareness, nurses are supporting the reduction of suicide rates at a policy level. Additionally, through providing data for research, the effects of stigma and importance of reducing stigma can be analysed and can be formed into policies. Priority Action Area 1 of the Australian National Suicide Implementation Strategy looks at the importance of raising awareness and support of Australians seeking help for suicide (National Suicide Prevention Project Reference Group, 2019). Raising awareness about mental health in the community reduces negative beliefs regarding suicide and poor mental health (Stuart, 2016). Greater awareness and acceptance will increase the number of people accessing care and services, and hopefully lead to a reduction in the suicide rate.

The Australian Government provides funding to various campaigns, organisations and general awareness raising activities. Some of these activities include the R U OK? Campaign, Suicide Awareness day and Beyond Blue to name a few (National Suicide Prevention Project Reference Group, 2019). Campaigns including these, play an important role in improving suicide literacy and improving individuals’ ability to seek or provide help. The Australian Government has also implemented Gatekeeper training (National Suicide Prevention Project Reference Group, 2019). A program that develops various members of the community, with skills and knowledge of recognising suicide behaviours, knowing when and how to intervene and even where to refer people if necessary (Lipson, Speer, Brunwasser, Hahn & Eisenberg, 2014).

These gatekeepers generally have a high number of social interactions with their community. Gatekeepers have reported finding a positive change in suicide intervention, peoples attitudes surrounding it as well as more people intervening to help other. This training is also available to nurses and health professionals through the Wesley Lifeforce Campaign, a commonwealth funded initiative (National Suicide Prevention Project Reference Group, 2019). These forms of suicide prevention have built community resilience by encouraging people to play an active role in supporting people with suicidal behaviours. Raising awareness about mental health as well suicide will encourage conversations that allow people to become more educated, speak more freely about these topics and provide better support to those vulnerable.

One of the World Health Organisation’s 11 elements of ‘Preventing Suicide: A global imperative’ is ‘Stigma Reduction’ (World Health Organisation, 2014). These 11 elements which have been adapted internationally for suicide prevention strategies has highlighted the vital importance of increasing awareness and reducing discrimination of seeking mental health help. Stigma reduction is crucial so that people feel comfortable accessing mental health services whilst simultaneously allowing people to feel supported to seek assistance when contemplating suicide.

In efforts to reduce the stigma around suicide the language used should be adapted to encourage openness in conversations and reduce discrimination. More awareness regarding the language of suicide would be greatly be beneficial. At a ward or community level, Mental Health Nurses use direct language when asking about suicidal ideation and self harm.

In 2011 Australian Press Council renewed the guidelines surrounding reporting suicide. This lead to the Australian media evaluating the way they presented and discussed mental health and specifically suicide (‘Standard: Suicide reporting’, 2011). This was done to ensure that it is reported responsibly and ensure people feel as if they can access care without discrimination. ‘Stigma Watch’ started by SANE Australia that regulates the way mental illness and suicide are represented in Australian media by provide constructive advice on how to report the information (‘What is StigmaWatch?’, 2019). It encourages people to report media coverage that stigmatises and irresponsibly reports suicide.

Mental Health nurses can play a vital role in the postvention process. Postvention is a term coined by the Psychologist and Suicidologist Dr. Edwin Shneidman in 1968 (Wilson & Marshall, 2010). It describes the counselling and the support provided to people bereaved of suicide. Suicide bereavement refers to the period of mourning and adjusting to daily life that is experienced by family, friends and anyone else effected by the loss of life (Australian Institute for Suicide Research and Prevention & Postvention Australia, 2017). In 2014, the World Health Organisation estimated that 800,000 people die annually from suicide, leaving between approximately 48 and 500 million individuals to be affected by the suicide. Postvention aims to “facilitate recovery after suicide and to prevent adverse outcomes including suicidal behaviour” (Andriessen, 2009, pp. 3).

These individuals also increased vulnerability to suicide themselves, as the grief they experience can be linked to higher prevalence of depression and anxiety (‘Standards and Guidelines for Suicide Bereavement Support Groups’, 2009). There is currently insufficient research done on the effects of postvention despite the link from the loss of someone to suicide to the mental health of those affected (‘Standards and Guidelines for Suicide Bereavement Support Groups’, 2009).

Many of the current policy recommendations and treatment options come from those with lived experiences. However for many of the bereaved avoiding the stigma have acted as deterrents to seeking care (Andriessen & Krysinska, 2011). This can lead to not having the ‘full picture’ of bereavement and what works best when developing treatments and effective service.

There needs to be further development in the guidelines and services from a clinical perspective to form better policies. Nurses have the ability to effect change in these policies by informing researchers on what is currently being done, and what can be done better in postvention care.

Many international countries, including Australia already have suicide prevention programs that have acknowledged and begun to implement postvention strategies. These postvention strategies are largely based around support-based resources such as support groups, brochures/ online resources, fundraising activities etc. In the Australian ‘Living is for Everyone’ Framework, the Outcome 5.3 ‘reduced incidence of suicide and suicidal behaviour in the groups at highest risk’ and Outcome 1.3 ‘application and continued development of the evidence base for suicide prevention among high risk populations’ notes the importance of supporting individuals bereaved by suicide (Department of Health and Ageing, 2007).

In the Victorian ‘Suicide Prevention Framework: 2016- 2025’, five objectives were released to approach to suicide prevention. Objective 1 is to ‘Build Resilience’ and Objective 2 is to ‘support Vulnerable People’ (Department of Health & Human Services, 2016). Objective 1 is about developing the ability to return from stress, difficult, distressing and traumatic situations. Objective 2 is about supporting the vulnerable groups and individuals a risk of suicide and specifically providing support for the individuals and communities bereaved by a suicide.

The vicarious trauma experienced through the loss, strain and grief of losing someone to suicide can make people vulnerable to self-harming and or suicidal behaviours. The Victorian ‘Suicide Prevention Framework: 2016- 2025’ aims to better involve support people, families and carers regarding discharge planning as well as further education and support (Department of Health & Human Services, 2016). Those bereaved by suicide, particularly family members may experience a lasting impact on their emotional, physical and mental health (Ramberg, Di Lucca & Hadlaczky, 2016). Different people will experience different levels of grief depending on various factors including their kinship to the person, the shock of the death or even being the person who finds the body.

Suicide is an important issue in 2019 Australia. As of 2017 the suicide rate was at 12.7 (age standardised) per 100,000 people. This an increase of from 11.7 in 2016. The number of Australians losing their life to suicide has grown by almost 10% in one year. The reasons people choose to intentionally end their lives varies from person to person. To prevent suicide, theses reasons must be carefully evaluated and acted upon.

Mental Health nurses have the potential to action change. Ensuring nurses maintain the skills and knowledge to treat and care for vulnerable individuals is important. The care nurses deliver must be person centred to ensure patients have the greatest chance at recovery. It is also important we continue working to reduce the stigma associated with suicide, so that people in our communities who need the help the most access it. In addition, we must also be aware of the psychological impact left behind on people who experience the loss of someone to suicide.

Whilst suicide is preventable, this does not mean it will be necessarily possible to reduce the rate to zero. We must work to reduce the rate so that more Australians have the opportunity to experience their best lives.

The topic of suicide and physician-assisted suicide has been one of the most polarized and debated topics in philosophy for hundreds of years. Suicide is such an important subject of philosophy because of how it can reveal the most important differences in similar moral systems. A philosophical examination of suicide is extremely important to conduct due to how negatively physician-assisted suicide is seen in the United States. In America, only nine states have legalized physician-assisted suicide. By examining the moral acceptability of suicide from different branches of philosophy, a moral framework for why PAS should be legal will be established and will show why PAS being illegal is antithetical to the inalienable rights that American’s are granted. Despite the common belief that any suicide is a choice, only an irrational mind can make, studies done by libertarian philosophers have noted that the ownership over one’s body gives the patient a claim right to exercise physician-assisted suicide.

In order to establish the foundations for whether or not a PAS is morally acceptable, we must first establish the right assertion for exercising a PAS. Checking the validity and soundness of the right-assertion using the Hohfeldian analytical system of rights will verify whether the right to a PAS can be grounded from a person’s axiomatic rights. The Hohfeldian analytical system of rights defines four components of rights, “Power, immunity, claim, and privilege” rights (Stanford). These categories are known as the Hohfeldian incidents. To create a systematic analysis of any right, one must assert how the right corresponds with one of these components or a combination of more than one to create a molecular right. The right to commit suicide can be broken down into power, immunity, and claim rights. The first of these, a power right, can be illustrated as such, “A has a power if and only if A has the ability to alter her own or another’s Hohfeldian incidents” (Stanford). This connects to the right to commit suicide by demonstrating one’s power over one’s life as follows, a patient has the power-right to take his or her life due to the right of non-interference, allowing a patient to choose to have a PAS if he or she so wished. The next component of the right to have a PAS is the immunity right. The immunity right states that “B has an immunity if and only if A lacks the ability to alter B’s Hohfeldian incidents” (Stanford). The immunity right is especially important in this analysis because it concerns whether or not the United States government has the right to stop a patient from having a PAS. The immunity right shows that because the US government lacks the power to alter any citizen’s Hohfeldian incidents, it also does not have the power to prevent a patient from having a PAS. The last of these categories, the claim right, is the most important, as it is classified as a first-order right as opposed to the other two rights which are second-order rights. A first-order right gives one a direct claim over his or her’s property and must be backed up through the establishment of second-order rights which in turn concern the alteration of first-order rights. The claim right for a PAS can be established as follows, A patient has a claim for a physician to provide them a PAS because physicians have a duty to patients to maximize the patient’s well-being. This means that not only is it morally acceptable for patients to have physician-assisted suicide but doctors may be morally obligated to assist. By combining the three “atomic” incidents the molecular right for a PAS is produced. This proves that patients who wish to seek a PAS not only have a sound right-assertion to do but that doctors are obligated to perform one.

Moreover, under a utilitarian framework, the act of suicide can be shown to be morally justified from a reversal of the rule that in order to act morally one must provide all the benefit to society as he can because of society’s benefit to him, that is: once you have committed suicide society can no longer provide a benefit to you, so you are no longer under a moral obligation to continue living and provide benefit to society. Hume writes on the subject of utilitarianism and suicide that, “All our obligations to do good to society seem to imply something reciprocal. I receive the benefits of society, and therefore ought to promote its interests; but when I withdraw myself altogether from society, can I be bound any longer?”. This view presents a person and his or her duty to society in a contractual way: in exchange for the goods and services the society provides, a person provides society with labor. By committing suicide, a person would effectively break the contract and thus both parties would no longer have an obligation to the other to provide support. This line of thinking lends more credence to an elderly person who may seek a PAS as they have already provided significant contributions to society and maybe morally permitted to have a PAS (Cholbi). One can also apply this logic to a person under significant pain, as for them, society has not been able to provide the person with support and thus the person is no longer morally obligated to stay alive and help support society. (ending sentence)

A common critique of the right to have a PAS holds that the need to keep oneself alive is A posteriori and therefore the desire to have a PAS must be irrational. This view supposes that a person contemplating suicide is making a decision to either stay in an alive state of being or to move to a dead state of being. Because one can not know what life is like once dead, then suicide must be an irrational choice. However, this view is incorrect because it supposes an incorrect view of the decision-making process of someone contemplating suicide. A person contemplating suicide is not making the choice to move to a different state of being but is instead choosing how long they wish to remain in his or her current state of being.

The best proof of a person’s right to have a PAS comes from libertarian philosophers and their assertion of the right of noninterference. The right of noninterference, as asserted by libertarian philosophers, shows that one’s ownership over their body and life gives one the final say and control over whether or not one should be allowed to have a PAS. This means that individuals enjoy an inalienable right to suicide that cannot be taken away from any other person or government. Under this view, any law that disallows having PAS can be seen as a coercive pathologization of exercises of free will that a person can take part in (Stanford). Because the right of noninterference stems directly from a general right to decide those matters that are most intimately connected to our well-being, then the right to have a PAS can be seen as A posteriori from this statement due to how general well-being is directly correlated with how one would want to change the duration of their life and the circumstances of their death. This shows that government bodies who prevent people from having PAS’s may be violating basic tenets of how liberty and rights are viewed in America.

In conclusion, physician-assisted suicide is not only morally acceptable under any standard ethical system but maybe morally obligated for doctors to perform given their commitment to ensuring a patient’s well-being. In America only nine states have allowed for physician-assisted suicide, leaving thousands of end-of-life patients suffering without the ability to take any action (CNN). The American congress must reconsider their views on this subject and take into account the fundamental liberties that afford every American control over their lives and bodies.