Suicide in the medically and terminally ill: Psychological and ethical considerations

For the clinician who works in a behavioral-medicine or primary-care settin g, this article presents the association between medical illness and suicid e. Specific illnesses such as HIV/AIDS, cancers of the brain and nervous sy stem, and multiple sclerosis all are associated with an increased risk of s uicide. Rates of major depression rise with increasing rates of serious med ical illness; however, depression and associated suicidal ideation tend to be undertreated in the medically ill. When medical illness becomes terminal , the clinician's patient may be confronted with difficult end-of-life deci sions. Great concern exists in the United States about the ethics of end-of -life decision making and the issue of physician-assisted suicide, The latt er part of this article examines the terminally ill patient's right to refu se life-sustaining treatments or to have death hastened according to the pr inciple of the "double effect." it also reviews psychologists' apparent acc eptance of the concept of rational suicide, as well as assisted suicide und er certain conditions; and offers several caveats. A reexamination of psych ology's role, standards, and principles with respect to rational suicide is recommended. (C) 2000 John Wiley a Sons, Inc.