Patient rights statements outline a set of voluntary or mandatory obligations. They define expectations for the relationship. They help to set the ethical tone for service.
There is a group that is indifferent to its needs and rights and lacks advocates to defend its interests. Customary patient rights statement do not accommodate them. No entitlements have been enumerated on their behalf.
This group is suicidal individuals, those in danger of completing suicide. They are beyond ideation. They have a doable plan and lethal means. Their state of mind and level of suffering cause them to see death as the only relief.
Suicidal individuals have the right:
- To have any expression of intent taken very seriously
- To have their suicidal risk viewed as their most serious problem.
- To be seen as wanting to be helped.
- To have their condition brought to the attention of someone in their life that cares for them.
- To know that they are experiencing a chemical deficiency in their bodies brought on by stress.
- To know that medications are available, which present viable means for stabilizing their situation.
- To acknowledgment of their pain, which may be physical, psychological, or emotional in origin.
- To intervention by those responsible for their care when they are manifesting critical symptoms.
There are several reasons that suicidal individuals need an explicit statement of rights:
Suicide has been characterized as "a permanent solution to a temporary problem." Suicide cannot be reversed. This warrants a higher duty to suicidal individuals.
There is also an implicit duty to potential survivors because of the especially hurtful aftermath of suicide. A set of rights is a "safety net" for the suicidal and for those who would be suicide survivors.
Suicide is often seen as a rational act. A growing body of research indicating that a neurochemical (serotonin) deficiency may play a role challenges this view. Other research linking depression to anomalies in brain physiology weaken the assumption that suicide is voluntary. A set of rights gives suicidal individuals the benefit of the doubt on volition and acknowledges their impairment.
Suicidality is not a recognized diagnosis. It is viewed as a symptom of depression or other disorders, which are not directly life threatening. This changes when someone becomes suicidal. Treatment of the primary disorder may do little to ameliorate acute suicidality. A set of rights enables suicidal individuals to stand out in terms of their distinct needs.
Suicide is much misunderstood by both the public and professionals. Stigma still accrues to suicide. These affect how suicidal individuals are regarded and treated. A set of rights lessens the effects of ignorance, indifference, and insensitivity.
Autonomy is our dominant bioethical principle. It shapes professional codes, patient rights statement, and treatment. It is the basis for the "right to die" and assisted suicide. Autonomy presumes capacity and capability, which are casualties of being suicidal. Autonomy may subordinate intervention to individual choice. Derivatives such as confidentiality and privacy limit disclosure and impede involvement of support systems. A set of rights counters these influences.
Severe stress and psychological pain are disenfranchising, distracting, debasing, and debilitating. They attack self-control and self-esteem. They generate fear, powerlessness, isolation, and leave helplessness in their wake. A set of rights empowers suicidal individuals and creates a context for maintaining control.
June 25, 1999
© Copyright 1999 Tony Salvatore