GESTIÓN EN SALUD PÚBLICA: Should we be more accepting of suicide in older adults?

lunes, 3 de septiembre de 2018

Should we be more accepting of suicide in older adults?

Should we be more accepting of suicide in older adults?

Bioedge

Should we be more accepting of suicide in older adults?

by Xavier Symons | 2 Sep 2018 | 1 comment

Suicide can be impulsive and precipitated by mental illness. But what about when an a healthy, older person makes a calm and considered decision to end their lives?

According to Dr. Meera Balasubramaniam, a geriatric psychiatrist at the New York University School of Medicine, it is not uncommon to find individuals who are very old yet healthy, and who desire to die.

“So many of our patients are confronting this in their heads.” Dr. Balasubramaniam told The New York Times.

She recently published an article in the Journal of the American Geriatrics Society exploring the motivations of 72 year old patient who, though not terminally ill, expressed a desire to end his life “while still doing well”. Balasubramaniam considers some of the factors that may have been motivating this patient’s suicidal ideation, including a desire for a sense of control, a revulsion at the effects of aging and illness on the body, and Baby Boomer libertarian sentiment.

Is such a form of suicide something we should be accepting?

Dr. Balasubramaniam said that her own views were “evolving”. “Discussing it [with patients] doesn’t mean your advocating it”, she said.

Dr Yeates Conwell, a geriatric psychiatrist at the University of Rochester School of Medicine and suicide researcher, has deep reservations. The vast majority of older patients who end their own lives have a mental illness, typically depression, and they tend to be acting impulsively. This is not a “rational act”, but rather equivalent to the forms of pathological suicide that we seek to prevent.

“The suicidal state is not fixed,” Dr. Conwell said. “It’s a teeter-totter. There’s a will to live and a will to die, and it goes back and forth”.

When health care providers aggressively treat seniors’ depression and work to improve their health, function and relationships, he said, “it can change the equation”.

Why do I keep screwing things up? This is, IMHO, the first question of moral philosophy. I know what the decent, sensible and right option is, and yet I choose the nasty, mad and wrong option. Bad ideas, said Plato. Bad education, said Rousseau. Desire, said Buddha. Capitalism, said Marx. Nature red in tooth and claw, said Darwin. Myself, I’m partial to the notion of Original Sin, which, as G.K. Chesterton observed, is the only Christian doctrine which can be proved by reading the newspaper.

The second question is how do I stop screwing things up? Theoretically, this can be solved without answering the first question. A number of bioethicists believe that we could live the good life if we spiked the water supply with a kind of morality fluoride. This sounds a bit too much like living as a Delta in Brave New World for my taste, but their concern is preventing very bad hombres from destroying the world. Perhaps the loss of a wide range of human emotions would be worth it.

However, there are other considerations – should we force people to drink the water? Should we tell them that their water has been spiked? All interesting questions – read all about in this week’s newsletter below.