-----Original Message-----
From: GP-UK [mailto:[log in to unmask]]On Behalf Of Julian Bradley


No.

However in the presence of any illness that means that the patient could
not make an informed and rational decision there is likely to be
considerable bias in favour of saving life if that is possible.

We all know that some people who kill themselves don't mean to, some have
changed their minds within seconds or minutes and many by the next morning,
and some who kill themselves while seriously depressed could have been
helped in a way that would have offered them a significant chance of
recovery and quality life.

Depression is contagious.  It's very easy to get sucked into a patient's
negative approach to their life.

Before acting upon the conclusion that a patient's expressed desire to kill
themselves was rational I'd want others involved.  One thing I have noticed
is that stated suicidal thoughts in people where suicide might seem
rational are often a cry for help in the same way as in others.  It can be
a statement about being made to feel a burden, about inadequate care or
pain relief, or some other soluble or changeable aspect of the problem.

Those who really wish to exercise informed choice, like many who are
depressed, don't alert anyone else.  They do what's to be done, and don't
leave notes or indeed responsibility resting with others.


FWIW,

Julian

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As always, Julian, a perceptive response. Many doctors do not appreciate the
subtle way in which depression distorts patient's outlook, making choices
(such as suicide) appear rational, when in fact they are not choices the
patient would make  in the same circumstances, if not depressed. I have
known patients with an unimpaired intellect make a very plausible case for
ending their lives and to look back on their arguments with surprise and
horror when they are better. It's very easy to get sucked into an abnegation
of our role by using the argument of rational choice and patient freedom.
Where a life may be lost, I think that the onus is on all who are aware of
the risk to do everything possible to reduce it. That said, and returning to
the original posting, protocols etc presuppose that all suicides are
preventable. They aren't.

Emile

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