COMMENTARY

Suicide and Communal Values: Ethical Implications for Psychiatrists

Ronald W. Pies, MD

Disclosures

January 27, 2014

In This Article

Our Collective Grief

No man is an island,
Entire of itself,
Every man is a piece of the continent,
A part of the main...
Any man's death diminishes me,
Because I am involved in mankind,
And therefore never send to know for whom the bell tolls;
It tolls for thee.

-- John Donne

I remember my uncle's final phone call with unusual clarity, because it came the same week in 1992 that Johnny Carson went off the air. In our yard, the late-May lilacs were starting to fade, and the warm weather was already easing us toward summer.

I had been out when my uncle phoned, but our answering machine picked up the message: He was calling because my mother had been "noodging" him -- not because he really wanted to speak with me. Having recently lost his job, my uncle sounded angry and enervated, as if he had marshaled his last bit of energy to fulfill this final duty. I tried calling him back, but there was no answer and no means of leaving a message.

A few days later, my uncle was dead of a self-inflicted gunshot wound, leaving a wife and 2 young children behind. More than 20 years later, the anguish of his suicide still tears at our family, and the questions we ask ourselves have never gone away: Could we have prevented this tragedy? Did we fail our loved one? Did we not see the clues? How could we have been so blind? What had we done to deserve such pain?

Psychiatrists are not moral philosophers by training, and the question of whether suicide is "immoral" is arguably the wrong one for psychiatrists to ask. As mental health professionals, we are, understandably, more concerned with the day-to-day challenges of detecting suicidal ideation; determining who is at high risk for suicide; and treating the psychiatric conditions most commonly associated with suicide, such as major depressive disorder.

Yet, as Dr. Cynthia M.A. Geppert points out, "the work of healing and caring is intrinsically about values and virtues." (Personal communication. December 1, 2013.) Thus, the ethical status of suicide is not a question that psychiatrists can ignore, any more than we can ignore human values in general. After all, our duty to preserve and protect life is founded on moral values, even if they are so deeply embedded in our medical ethos that we no longer sense their moral underpinnings.

Recently, the moral status of suicide has been scrutinized by the poet and philosopher Jennifer Michael Hecht in her book Stay: A History of Suicide and the Philosophies Against It.[1] Hecht wrote the book in the aftermath of 2 suicides -- both victims were close friends and fellow poets. In essence, Hecht argues that suicide cannot be evaluated solely in terms of "personal autonomy," as some modern ethicists might claim; rather, we must hold suicide up to the clarifying light of communal values.

In an audiotape accompanying her book, Hecht argues that "when a person kills himself, he does wrenching damage to the community." In general, I agree -- and this damage, arguably, may be counted among the "moral harms" of deliberate self-destruction.

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