Rational Suicide in Late Life: A Systematic Review of the Literature.

Carla Gramaglia,Raffaella Calati,Patrizia Zeppegno

doi:10.3390/medicina55100656

Abstract

Background and Objectives: The complex concept of rational suicide, defined as a well-thought-out decision to die by an individual who is mentally competent, is even more controversial in the case of older adults. Materials and Methods: With the aim of better understanding the concept of rational suicide in older adults, we performed a systematic review of the literature, searching PubMed and Scopus databases and eventually including 23 published studies. Results: The main related topics emerging from the papers were: depression, self-determination, mental competence; physicians’ and population’s perspectives; approach to rational suicide; ageism; slippery slope. Conclusions: Despite contrasting positions and inconsistencies of the studies, the need to carefully investigate and address the expression of suicidal thoughts in older adults, as well as behaviours suggesting “silent” suicidal attitudes, clearly emerges, even in those situations where there is no diagnosable mental disorder. While premature conclusions about the “rationality” of patients’ decision to die should be avoided, the possibility of rational suicide cannot be precluded.

Highlights

Suicide is a global phenomenon accounting for 800,000 deaths worldwide every year [1].Considering the global aging trends in the world and that suicide rates increase with age, suicide in older adults cannot be neglected [2,3,4]
Studies were excluded if: (1) they were written in languages other than English; (2) their full-text was not available; (3) they were book chapters, commentaries and editorials/letters to the editor; (4) they were focused on euthanasia, physician assisted death (PAD) and physician assisted suicide (PAS)
Focus on the comparison between older people with and without terminal cancer who died by suicide, and analysis of motives for suicide

Summary

Introduction

Suicide is a global phenomenon accounting for 800,000 deaths worldwide every year [1].Considering the global aging trends in the world and that suicide rates increase with age, suicide in older adults cannot be neglected [2,3,4]. Most depressed older adults do not become suicidal. The complex concept of rational suicide, defined as a well-thought-out decision to die by an individual who is mentally competent, is even more controversial in the case of older adults. Materials and Methods: With the aim of better understanding the concept of rational suicide in older adults, we performed a systematic review of the literature, searching PubMed and Scopus databases and eventually including 23 published studies. Results: The main related topics emerging from the papers were: depression, self-determination, mental competence; physicians’ and population’s perspectives; approach to rational suicide; ageism; slippery slope. Conclusions: Despite contrasting positions and inconsistencies of the studies, the need to carefully investigate and address the expression of suicidal thoughts in older adults, as well as behaviours suggesting “silent” suicidal attitudes, clearly emerges, even in those situations where there is no diagnosable mental disorder. While premature conclusions about the “rationality” of patients’ decision to die should be avoided, the possibility of rational suicide cannot be precluded.

Objectives

Methods

Results

Discussion

Conclusion