Rational Suicide in Elderly Adults: A Clinician's Perspective

Meera Balasubramaniam, MD, MPH


J Am Geriatr Soc. 2018;66(5):998-1001. 

In This Article


Death evokes emotions that are deeply personal and dynamic. In some situations, bringing an end to suffering may seem kinder and more compassionate than letting it continue. As a clinician, I have wondered if the absence of a diagnostic category to describe a mental state in which suicide appears like the best option reflects a flaw in the nosology or whether it is indeed a rational entity that we are increasingly beginning to encounter as views about health, choice, and control continue to evolve in a society that is unprepared for prolonged old age. The idea of suicide among non–terminally ill elderly adults is, as it should be, a challenging concept, but it is important that clinicians, when confronted with such scenarios, ask detailed and direct questions involving death and suicide rather than being fearful of or judgmental about these discussions. Research in psycho–oncology has examined the desire for hastened death as a construct in severely medically ill individuals. Risk factors for the desire for hastened death have been enumerated, and rating scales such as the Desire for Death Rating Scale and the Schedule of Attitudes towards Hastened Death have been developed and may be used in the clinical assessment of rational suicide in elderly adults.[25] In addition, original research that focuses on obtaining the perspectives of non–terminally ill older adults about themes of aging, dependence, death, and suicide is needed. Our individual beliefs about the rationality of suicide aside, it is imperative that we as a field strive to learn more, because many of our older patients are already confronting it. We owe it to them to explore their beliefs with compassion, depth, and clinical curiosity.