Rational Suicide: A complex ethical dilemma

Let’s dive into the complex and thought-provoking topic of rational suicide. It’s a subject that’s been stirring up quite a debate in medical, ethical, and philosophical circles. Let’s unpack this together.

First off, what exactly is rational suicide? Well, it’s not your typical impulsive act. We’re talking about a well-thought-out decision to end one’s life, made by someone who’s mentally competent and has carefully weighed up all the options and consequences. It’s a concept that challenges the idea that all suicides are inherently irrational or stem from mental illness.

Now, let’s look at the arguments for and against. On one side, we have the champions of personal autonomy. They reckon that we should have the right to make decisions about our own lives, including how and when to end them. It’s all about self-determination and respecting an individual’s choices based on their values and circumstances.

For some folks facing terminal illnesses or chronic, debilitating conditions, rational suicide might be seen as a way to avoid prolonged suffering and maintain dignity. It’s about having control over one’s fate and finding peace in a difficult situation.

But it’s not all straightforward. Critics worry that accepting rational suicide could lead us down a slippery slope. There are concerns that vulnerable individuals might be pressured into ending their lives, or that society might start viewing suicide as an acceptable solution to life’s challenges.

And let’s be honest, determining whether a suicide is truly ‘rational’ is no easy task. Mental health conditions, temporary crises, or external pressures can all influence decision-making, making it tricky to ensure the choice is genuinely autonomous and well-reasoned.

We also can’t ignore the impact on loved ones. Even when considered rational, suicide can have profound and lasting effects on family, friends, and communities. It’s a heavy emotional toll that shouldn’t be taken lightly.

Now, here’s where it gets really interesting. The idea of ‘rescuing’ suicidal individuals has deep roots in our society. It’s tied up with the rise of modern psychiatry and how we’ve come to view mental health. And there are quite a few groups that benefit from this belief:

1. Mental health professionals, whose work is validated by this approach
2. Pharmaceutical companies, who provide medications for mental health issues
3. Religious institutions, which often emphasise the sanctity of life
4. Suicide prevention organisations, whose very existence depends on the idea that suicide can and should be prevented
5. Society at large, reinforcing the value we place on human life

For mental health practitioners, it’s a real ethical tightrope walk. They have to balance their duty to prevent suicide with respecting patient autonomy. Imagine trying to maintain a strong therapeutic relationship while potentially acting against a patient’s expressed wishes. It’s no small feat.

I’ll provide you with the most recent and reliable statistics available on suicide. Please note that suicide statistics can be challenging to compile accurately due to underreporting and differences in reporting methods across countries.

Attempted Suicides vs. Successful Suicides:

Worldwide:
Exact global figures for attempted suicides are difficult to obtain due to underreporting. However, the World Health Organization (WHO) estimates that for each adult who dies by suicide, there may be more than 20 others attempting suicide [1].

For males versus females worldwide:

• Globally, the suicide rate for males is 12.6 per 100,000 population
• For females, it’s 5.4 per 100,000 population [2]

In Australia:
According to the Australian Institute of Health and Welfare (2021) [3]:

• The suicide rate for males is 18.6 per 100,000 population
• For females, it’s 5.7 per 100,000 population
• Suicide is a leading cause of premature death, accounting for the highest number of potential years of life lost (108,762). People who died by suicide had a median age at death of 45.6
• Three-quarters (75.6%) of people who died by suicide were male. Deaths due to suicide were the highest ranked external cause of death in males

According to the Australian Bureau of Statistics (2024) [5]:

• In 2022, 3,249 Australians died by suicide
• The crude death rate for deaths due to suicide was 12.5 per 100,000 people
• The age-standardised suicide rate was 12.3 per 100,000 people
• For females in 2022, there were 794 deaths due to suicide
• For males in 2022, there were 2,455 deaths due to suicide
• For females, 15.5% of suicides occurred in those aged under 25 years
• For males, 10.5% of suicides occurred in those aged under 25
• In 2022, suicide was the leading cause of death for those aged between 15-44 years. 
• Suicide was the leading cause of premature mortality with 108,762 years of life lost.
• A person who died by suicide lost on average 35.6 years of life. 
• For males who died in 2022, suicide was the leading cause of premature mortality with 80,958 years of life lost.
• Those who died by suicide lost on average 34.9 years of life.
• For females who died in 2022, suicide was the leading cause of premature mortality with 27,893 years of life lost.
• Those who died by suicide lost on average 37.7 years of life.

Suicide of children

Deaths of children by suicide is an extremely sensitive issue. The number of deaths of children attributed to suicide can be influenced by coronial reporting practices. Reporting practices may lead to differences in counts across jurisdictions and this should be considered when interpreting tabulations and analysis of suicide deaths in children presented below. For the purposes of the ABS report [5], children are defined as those aged between 5 and 17 years of age. The ABS are not aware of any recorded suicides of children under the age of 5 years.

In 2022: 

• The suicide rate in Queensland decreased by 54.3%. Queensland and was the largest contributor to the overall decrease in suicides of children between 2021 and 2022.
• There were 77 children who died by suicide. This is the lowest number of suicides of children in five years.  
• Suicide accounted for 15.5% of child deaths.
• Suicide was the second leading cause of child death in Australia, after land transport accidents. This is a reduction from previous years; suicide has been the leading cause of death in children since 2013.  
• Males had a suicide rate of 2.2 per 100,000 children (47 deaths).
• Females had a suicide rate of 1.5 per 100,000 children (30 deaths).
• Over 80% of children who died by suicide were aged 15-17 years (64 deaths).
• The sex ratio for children aged 5-17 years was 1.6 males per female death. This compared to a sex ratio of 3.1 for people of all ages who died by suicide.
• The sex ratio for children has remained consistent over the last 10 years.

Suicide risk factors by age

The types of risk factors experienced by a person can vary across their life. Risk factors more commonly seen in persons in older age groups, such as pain and limitation of activities due to chronic health conditions, are not as common in younger age groups. Similarly, problems related to employment and unemployment are most common in those included in the working age population (defined as 15-64 years). 

In 2022:

• Mood disorders (including depression) were the most common risk factor to be mentioned in all age groups except those aged 85 years and over.
• Limitation of activities due to illness and disability continues to be the most common risk factor for those aged 85 years and over.
• Suicide ideation was mentioned as a risk factor in at least one fifth of suicide deaths across all age groups. Suicide ideation can include thoughts or contemplation of suicide, and both direct and indirect discussions or comments surrounding a person’s intention or wish to end their life.
• Those aged under 45 years were most likely to have issues with psychoactive substance use (both acute use and intoxication, as well as chronic use) mentioned as a risk factor.
• Those aged 65 years and over were most likely to have chronic health conditions and pain mentioned as a risk factor.
• Factors relating to employment and unemployment were most commonly mentioned as a risk factor in those aged 45-64 years.

Suicide risk factors for males

In 2022 for males who died by suicide: 

• Mood disorders (including depression) were the most common risk factor to be mentioned overall, as well as for those aged 5-24, 45-64 and 65-84 years.
• The top risk factor for males aged 25-44 years was problems in spousal relationships circumstances, present in over one-third of suicides. Problems in spousal relationships overtook mood disorders as the top risk factor in this age group for the first time and can include separation and divorce as well as arguments and domestic violence situations.
• There was overall a higher proportion of acute substance abuse disorders than chronic substance abuse disorders identified.
• Males aged 25-44 years were the most likely age group to have substance abuse mentioned as a risk factor, including:
  • Acute psychoactive substance use and intoxication (20.6%)
  • Chronic psychoactive substance abuse disorders (20.0%)
  • Acute alcohol use and intoxication (19.5%)
  • Chronic alcohol abuse disorders (14.8%).

Suicide risk factors for females

In 2022 for females who died by suicide:

• Mood disorders (including depression) were the most common risk factor, being captured as a risk factor in over 40% of all female suicides, and over 50% of suicides of females aged 45-64 years.
• Personal history of self-harm was the most common risk factor for those aged under 25 years.
• Suicide ideation was mentioned as a risk factor in over one quarter of suicides in every age group.
• Overall, substance abuse was less commonly mentioned as a suicide risk factor for females than for males.
• Acute psychoactive substance use was the most common form of substance abuse for those aged 5-24 years.
• For all other age groups, the most common form of substance abuse was either acute or chronic alcohol use.

For suicides across 2018-2022:

• Problems in spousal relationships and personal history of self-harm are the two most common psychosocial risk factors recorded across these years. 
• Problems in relationships with family and friends (excluding spousal relationships) has returned to the top 10 risk factors in 2022.

Regarding attempts:

• It’s estimated that for every death by suicide, there are between 10 and 30 attempts
• Women are more likely to attempt suicide, but men are more likely to die by suicide

World Statistics on Successful Suicides:

The WHO reports that approximately 703,000 people die by suicide every year worldwide [2].

Countries with the Least Number of Suicides (per 100,000 population) [4]:

1. Antigua and Barbuda (0.4)
2. Barbados (0.4)
3. Grenada (0.5)
4. Saint Vincent and the Grenadines (0.7)
5. Saudi Arabia (0.8)

Countries with the Highest Number of Suicides (per 100,000 population) [4]:

1. Lesotho (72.4)
2. Guyana (40.3)
3. Eswatini (29.4)
4. South Korea (28.6)
5. Kiribati (28.3)

It’s important to note that these statistics can vary based on the source and the year of data collection. Additionally, lower rates in some countries may be due to underreporting or cultural stigma around suicide.

References:

[1] World Health Organization. (2021). Suicide. https://www.who.int/news-room/fact-sheets/detail/suicide

[2] World Health Organization. (2021). Suicide worldwide in 2019: Global Health Estimates. https://www.who.int/publications/i/item/9789240026643

[3] Australian Institute of Health and Welfare. (2021). Suicide & self-harm monitoring. https://www.aihw.gov.au/suicide-self-harm-monitoring/data/deaths-by-suicide-in-australia/suicide-deaths-over-time

[4] World Population Review. (2023). Suicide Rate by Country 2023. https://worldpopulationreview.com/country-rankings/suicide-rate-by-country

[5] Australian Bureau of Statistics. (2024). Causes of Death, Australia.
https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/2022

Regarding the rate of suicide attempts versus suicide achieved, this phenomenon is often referred to as the “gender paradox” in suicide research. Let’s look at some specific data, focusing on Australia and then expanding to worldwide figures where available.

Australia:

According to the Australian Bureau of Statistics (ABS) [1]:

1. In 2021, the age-standardised suicide rate for males was 18.0 per 100,000, compared to 6.1 per 100,000 for females.
2. This means that for every female suicide, there were approximately 3 male suicides.
3. However, the rate of hospitalisation for intentional self-harm (which can be an indicator of suicide attempts) shows a different pattern. In 2019-20 [2]:

• For females: 249 hospitalisations per 100,000 population
• For males: 177 hospitalisations per 100,000 population

This suggests that women in Australia are about 1.4 times more likely to be hospitalised for intentional self-harm than men.

Worldwide:

The World Health Organization provides some global insights [3]:

1. Globally, the suicide rate for males is 12.6 per 100,000 population, compared to 5.4 for females.
2. This means that men die by suicide at a rate approximately 2.3 times higher than women globally.
3. However, in low- and middle-income countries, the male-to-female ratio for suicide is lower, at 1.6 males for every female.
4. In high-income countries, this ratio is much higher at 3.5 males for every female.

Regarding suicide attempts, a study published in the American Journal of Public Health [4] found that:

1. Women were 1.2 times more likely to have attempted suicide than men.
2. However, men were 3.5 times more likely to die by suicide than women.

The reasons for this disparity are complex and multifaceted, but some factors often cited include:

1. Method lethality: Men tend to use more immediately lethal methods in suicide attempts.
2. Help-seeking behaviours: Women are generally more likely to seek help for mental health issues.
3. Cultural and societal factors: Differing expectations and pressures on men and women can influence suicidal behaviour.

It’s important to note that these statistics represent broad trends and may not reflect individual experiences. Each person’s situation is unique and requires individual consideration and care.

References:

[1] Australian Bureau of Statistics. (2022). Causes of Death, Australia. https://www.abs.gov.au/statistics/health/causes-death/causes-death-australia/latest-release

[2] Australian Institute of Health and Welfare. (2022). Suicide & self-harm monitoring. https://www.aihw.gov.au/suicide-self-harm-monitoring/data/intentional-self-harm-hospitalisations/intentional-self-harm-hospitalisations-demographic-factors

[3] World Health Organization. (2021). Suicide worldwide in 2019: Global Health Estimates. https://www.who.int/publications/i/item/9789240026643

[4] Canetto, S. S., & Sakinofsky, I. (1998). The Gender Paradox in Suicide. Suicide and Life-Threatening Behavior, 28(1), 1-23. https://pubmed.ncbi.nlm.nih.gov/9560163/

Remember, if you or someone you know is struggling with thoughts of suicide, please reach out to a mental health professional or a suicide prevention hotline immediately (useful numbers and websites below).

As we continue to grapple with these complex issues, it’s crucial that we approach the topic with nuance and compassion. We need to ensure we’re providing ethical, effective care while respecting individual autonomy.

The debate around rational suicide really highlights the need for comprehensive mental health support, improved palliative care, and ongoing dialogue about the complex issues surrounding life, death, and personal choice. It’s a challenging topic, but by engaging with it, we can work towards a more nuanced and compassionate approach to mental health care and suicide prevention.

Remember, if you’re struggling with thoughts of suicide, please reach out for help. You’re not alone, and there are people ready to support you.

Further notes:

Mental health professionals:
The mental health workforce in Australia has grown significantly, reflecting the increased demand for these services. According to the Australian Institute of Health and Welfare, the number of psychiatrists increased by 17% between 2013 and 2018, while the number of mental health nurses grew by 8% [1].

The Australian Psychological Society reports over 24,000 registered psychologists in Australia as of 2021 [2]. This growth in the mental health workforce aligns with the increasing recognition of mental health issues and the need for professional intervention.

Pharmaceutical companies:
The Australian pharmaceutical market was valued at AUD 25.9 billion in 2020 and is expected to reach AUD 31.1 billion by 2026 [3]. Antidepressants are among the most commonly prescribed medications in Australia. In 2018-19, there were 27.3 million prescriptions for antidepressants, representing a 95.4% increase since 2008-09 [4].

Religious institutions:
While specific data on the role of religious institutions in suicide prevention in Australia is limited, research has shown that religious beliefs can be a protective factor against suicide. A study published in the Journal of Religion and Health found that individuals with religious affiliations generally had lower rates of suicide attempts [5].

Suicide prevention organisations:
Funding for suicide prevention in Australia has increased significantly in recent years. The Australian Government committed $461 million to suicide prevention from 2021 to 2026 [6]. This funding supports various suicide prevention organisations and initiatives across the country.

Society at large:
The Australian government’s commitment to mental health and suicide prevention reflects societal values. The National Mental Health and Suicide Prevention Plan 2021-2026 outlines a whole-of-government approach to improving mental health outcomes and reducing suicide rates [7]. This plan involves significant investment and cross-sector collaboration, demonstrating the societal importance placed on these issues.

References:

[1] Australian Institute of Health and Welfare. (2020). Mental health services in Australia. https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia

[2] Australian Psychological Society. (2021). Psychology in Australia: Snapshot. https://psychology.org.au/about-us/psychology-in-australia

[3] GlobalData. (2021). Australia Pharmaceutical Market Overview. https://store.globaldata.com/report/gdhe0118mar–australia-pharmaceutical-market-overview-2026/

[4] Australian Institute of Health and Welfare. (2020). Mental health-related prescriptions. https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/report-contents/mental-health-related-prescriptions

[5] Lawrence, R. E., Oquendo, M. A., & Stanley, B. (2016). Religion and Suicide Risk: A Systematic Review. Archives of Suicide Research, 20(1), 1-21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990512/

[6] Australian Government Department of Health. (2021). Budget 2021-22: Prioritising Mental Health, Preventive Health and Sport. https://www.health.gov.au/ministers/the-hon-greg-hunt-mp/media/budget-2021-22-prioritising-mental-health-preventive-health-and-sport

[7] Australian Government Department of Health. (2021). National Mental Health and Suicide Prevention Plan. https://www.health.gov.au/resources/publications/the-australian-governments-national-mental-health-and-suicide-prevention-plan

---

Here’s a list of organizations in Australia that provide support for those considering suicide, those affected by suicide, and specific support for members of the Armed Forces, veterans, and their families:

General Suicide Prevention and Support:

Lifeline Australia
Phone: 13 11 14 (24/7)
Website: www.lifeline.org.au

Beyond Blue
Phone: 1300 22 4636 (24/7)
Website: www.beyondblue.org.au

Suicide Call Back Service
Phone: 1300 659 467 (24/7)
Website: www.suicidecallbackservice.org.au

SANE Australia
Phone: 1800 18 7263
Website: www.sane.org

Support for Those Bereaved by Suicide:

StandBy Support After Suicide
Phone: 1300 727 247 (24/7)
Website: www.standbysupport.com.au

Grief Centre
Website: www.griefcentre.org.au

The Compassionate Friends
Phone: 1300 064 068
Website: www.compassionatefriends.org.au

Support for Armed Forces, Veterans, and Their Families:

Open Arms – Veterans & Families Counselling
Phone: 1800 011 046 (24/7)
Website: www.openarms.gov.au

Defence Family Helpline
Phone: 1800 624 608 (24/7)
Website: www.defence.gov.au/members-families/Defence-Member-Family-Helpline

Soldier On
Phone: 1300 620 380
Website: www.soldieron.org.au

Mates4Mates
Phone: 1300 4 MATES (62837)
Website: www.mates4mates.org

Legacy Australia
Phone: 1800 LEGACY (534 229)
Website: www.legacy.com.au

RSL DefenceCare
Phone: (02) 8088 0388
Website: www.rslnsw.org.au/rsl-defencecare

Australian Kookaburra Kids Foundation (for children of veterans with mental illness)
Phone: 1300 566 525
Website: www.kookaburrakids.org.au

Remember, these organizations offer various services including crisis support, counselling, information, and referrals. If you or someone you know is in immediate danger, please call emergency services on 000.

---

Specific Support Programs:

1. beyondblue’s NewAccess program:
This is a free mental health coaching program for anyone feeling stressed, anxious, or overwhelmed. It’s delivered via phone or video call and doesn’t require a referral.

2. Lifeline’s Crisis Support Chat:
This online chat service provides short-term support for people in crisis, available 7 days a week.

3. Open Arms’ Safe Zone Support:
This is an anonymous counselling service specifically for veterans and their families, accessible via phone or online chat.

4. StandBy’s Support After Suicide program:
This offers personalised support to individuals, families, and communities affected by suicide, including face-to-face, telephone, and online support.

5. Soldier On’s Pathways Program:
This program assists veterans in finding meaningful employment through career coaching, employment support, and education.

How These Organisations Help:

1. Crisis Intervention:
Organisations like Lifeline and Suicide Call Back Service provide immediate support to individuals in crisis. They offer 24/7 phone lines staffed by trained crisis supporters who can provide emotional support, crisis intervention, and safety planning.

2. Counselling Services:
Many organisations, including beyondblue and Open Arms, offer professional counselling services. These can be short-term or ongoing, and are often available through various mediums (phone, online, face-to-face).

3. Peer Support:
Groups like Mates4Mates and The Compassionate Friends facilitate peer support networks. These allow individuals to connect with others who have similar experiences, fostering a sense of community and shared understanding.

4. Education and Resources:
Organisations such as SANE Australia provide extensive online resources, fact sheets, and educational materials about mental health, suicide prevention, and coping strategies.

5. Practical Support:
Legacy Australia, for instance, provides practical assistance to families of deceased veterans, including financial support, advocacy, and social activities.

6. Referral Services:
Many of these organisations act as gateways to other services. They can provide referrals to appropriate healthcare providers, support groups, or other relevant services based on an individual’s specific needs.

7. Community Outreach:
Organisations like StandBy Support After Suicide work within communities to provide postvention support, helping to prevent further suicides and support those affected.

8. Family Support:
The Australian Kookaburra Kids Foundation provides respite camps and activities for children of veterans with mental illness, offering them a break and a chance to connect with peers in similar situations.

9. Rehabilitation and Reintegration:
Soldier On and RSL DefenceCare offer programs to help veterans transition back to civilian life, including employment assistance, skills training, and social connection activities.

These organisations often work collaboratively, forming a network of support that can address various aspects of an individual’s or family’s needs. They aim to provide holistic care, recognising that mental health, suicide prevention, and recovery involve multiple facets of a person’s life.

Remember, while these services are invaluable, they’re not a substitute for professional medical advice. If you or someone you know is in immediate danger, always call emergency services on 000.