Suicide: An Ethical Typology

English: Skull and crossbones

English: Skull and crossbones (Photo credit: Wikipedia)

Suicide: An Ethical Typology

Three distinct forms of suicide may be identified based on the role that a clinician plays in the process:

  1. Unassisted Suicide
  2. Facilitated Suicide
  3. Assisted Suicide
Unassisted Suicide

This may take two forms. The first applies where the victim completes suicide while not currently or recently in the care of a clinician. The second applies where the victim was currently under care but not for a condition associated with suicidality. The clinician had no basis to assume or suspect risk. The victim did not confide any ideation, plan, or threat or did not acknowledge such behavior if queried by the clinician.

Facilitated Suicide

This applies where the victim completes suicide while currently or recently in the care of a clinician and where these factors were present:

  • A clinical or custodial relationship existed
  • The clinician or provider had knowledge of the risk
  • Means of prevention or intervention were available

A suicide in this context suggests a breach of duty. This could include ignoring the danger, and/or not effectively using resources that may have ameliorated the risk.

In such cases, the suicide has, in effect, been facilitated. This is not to say that the clinician caused the suicide. The ethical failing was doing nothing or acting passively or conservatively despite the client’s mortal danger.

Assisted Suicide

This applies where a clinician with knowledge of the individual’s wishes and consent enables completion by providing the lethal means and guidance as to use. This mode assumes capacity and rationality. However, most victims of assisted suicide appear driven by extreme stress and/or chronic intractable pain which impair capacity and rationality. Enabling the suicide of such individuals, statutes to the contrary, is unethical.

Volition and Suicide

Assisted suicide is justified, by its advocates, as a personal right. Unassisted suicide is customarily characterized as a personal decision. Where does that leave facilitated suicide? Consider the following:

  • Assisted Suicide = Voluntary Action
  • Facilitated Suicide = Involuntary Action
  • Unassisted Suicide = Nonvoluntary Action
The codes of conduct guiding clinicians are often inadequate in addressing duty to those who are at risk of becoming suicidal or who are suicidal.

Assisted suicide is voluntary when the individual is determined to be capable of independently making the decision. Facilitated suicide is involuntary because the individual made a “cry for help” to a clinician that went unheeded. Unassisted suicide is nonvoluntary in the same way that death as the result of any disease is so.

A somewhat similar typology is offered by Fairbairn (1995)in Contemplating Suicide: The Language and Ethics of Self-Harm:

The most obvious variety of a suicide act involves the suicide actively bringing harm to himself. However, suicide may also be achieved by the direct action of another, by the omissions to act of either the suicide or another, and by the suicide’s putting himself in the way of events that he intends and expects to kill him.

For a fuller discussion of this topic see: Anthony Salvatore (2000) “Professional Ethics and Suicide: Toward an Ethical Typology” Ethics, Law, and Aging Review (6) pp. 257-269

via The Ethics Side of Suicide.

My conflictions with my worker

Worries & Concerns In human life and mental re...

Worries & Concerns In human life and mental relationship in form of a Mind Map. (Photo credit: Wikipedia)

I wonder how it is that one week my support worker and I could have such a good week and the week before we had a week filled with anger and rage so much that I thought I would never be able to face her without feeling so much hurt and resentment from my past and taking it out on her. Then it exploded inside of me and came out not without truth to what I was saying to her but what she felt was misdirected at her though to me there was much truth the rage was misdirected the subject that was at hand was the trigger of my rage but gave me no right to direct that anger and rage towards her. I wish I could take it back but cannot.

Now I sit here feeling hurt again as she blew me off in a way, though we had talked about her not coming today earlier in the week and I offered her to not come tonight so she could visit with her son since she was going out-of-town where he lives but she said she would let me know. Then as she left my house last night she said she would be over tonight. Though now she blew me off. I even texted her about something that has been on my mind most of the day and I was going to talk to her about when she came and she did not respond. That was more than an hour after she was supposed to be here. Then I called her more than 2 hours after she was supposed to be here and she did not answer. It is these times that I tend to worry something happened to her and her family while driving because they drive so many places and on trips alot and worries me. I always worry she is going to e gone out of my life, that something is going to happen to her. Especially in times like this when she ignores me or she blows me off which is not that often that she blows me off most of the time she easily tries to explain it away as a misunderstanding. But it worries me alot.

Then I also feel hurt that she had told me that she would be here tonight and did not show up and never called me and now did not respond to my text or answer my call. It is like she purposely is now ignoring now that she did not show up. then she will usually use some excuse about her phone being dead, or that she left it in the car, or it was downstairs on the charger, or she left it at home, or that she just realized she missed my call. I just do not understand how it is that she tries so hard to get me to trust her and then hurts me like this. She tries to make me believe that I am cared about and I matter then she does stuff like this that only proves to me I don’t and that she does not really care and that I do not matter and that it is more of a job to her than she claims now than it was a year ago when we began to work together. Even her whole attitude and emotional aspect towards the work has changed. It is like she no longer has the passion she had when I started working with her. Maybe I fucked it all up. Maybe I burned her out and should just walk away and let her get her passion back so she can help others.

She really is a great worker and I really messed things up. Maybe it is just me she no longer truly wants to work with though she says she does and she claims to really care about but yet it just feels especially at times like this that she is blowing me off and does not care how it affects me or what outcome comes from it. Well owell guess it really does not matter. Guess it only matters to me. It does not truly matter to her.

lost in questions

 

You ever have a conversation with someone but really do not want to have the conversation? Have you ever had things to say during a conversation but yet tried your best to sensor that what you say to the other person not wanting to hurt them or anger them, not wanting to make them hate you? Have you ever gotten angry at someone for no reason? Do you ever get angry at someone and cannot figure out the reason but yet know there are several reasons why you should be angry with them? Do you ever wonder why you are okay with things but yet nothing will happen and you all a sudden get angry? Have you ever wondered why such little things can happen and can feel such immense emotion over them? Are your emotions ever triggered into past emotions by current happenings even though it is truly not the current situation that is the true emotionally distressing situation but yet the core issues inside you that you refuse to face is interfering in your life so much it is almost impossible to avoid the emotional triggering. It is almost impossible to avoid the triggering but yet it seems as if it is the current surface issue that is causing the distress and emotional response when in fact is the past that is surfacing and becoming unavoidable that you keep trying to ignore and run from. How do you rid yourself from those underlying core emotional issues without facing your past? How do you ignore the overload and spillage into your current life and get the boiling over to simmer down? i am trying hard no to deal with or have to face and trust anyone in life with my secrets of the past. I am trying hard not to let my walls be penetrated. I am trying hard to make people in my realize and understand I was not meant to be cared about, loved, heard, understood, and that I am supposed to be alone, hopeless, hurt, unloved, and hated. So by them breaking through my walls all they have done is caused me to make them bigger and stronger.By them caring it makes me angry. I know that sounds irrational since all I do in life is desire to be cared about and loved but yet when it happens I cannot trust it as too many people in my life claim they cared, claimed they loved me, claimed they never would hurt me and walk away from me, but yet in the end they did all this. They walked away, hurt me more than I was hurt before they came into my life, well most of them anyway, not sure they ever really cared since they claimed they did but yet only cared during the times we were around each other or when they needed something from me, and when people claimed to love me I always paid a price either by physically being abused and then being told they loved me, or by sexually having to give into someone sexually with my body being their payment for what they claimed was their love and so I am not sure I really know what love is and or how to experience and except love and care from anyone in life.

 

The day was great until the moment of ruin

So today, I was having a great day. I had a nice cookout with some “friends” and our mental health support worker. She leaves tomorrow for an 11-day vacation to visit her family and celebrate her 50th Birthday. What a milestone that is in someone’s life considering I am not sure I will ever make it that far or long in life. Overall, it was a really nice time and I enjoyed myself and had a great time spending time with one of their 5-year-old sons. We climbed the tree and I hope he had fun too. As there really was no entertainment for him but I tried to make it fun for him also. I no longer have my ids so I no longer have toys for his age as I ridded myself of all the toys finally after lugging them around for so long. The last of them went right before I moved into this building last year. I held onto them way too long after my kids were long gone but finally had enough closure I was able to let go of them and sometimes regret it but I did it and it was therapeutic when I got rid of the last one before moving here which was my son Daniel’s remote control truck I had bought him for his Birthday in 2006.

So anyways my enjoyment stopped when the it was time for the child and his mother to leave and she was not paying attention to him and listening when he was trying to tell her something as she was talking to me and had the food in her hand that I was sending home with them and her laptop in her other hand. He pulled on her arm to get her attention and she dropped the food and in angered yelled at him and hit him. I was very angry with her and saddened. She them turned to me and told me well there it is you will have to pick it up I will call you later and walked away yelling at the child about the food after she had just abused him. I was angry with her. I was saddened for the child. This was not the first time I have seen her do this but this was the first time she had publically done this to him in front of a counselor and other people who did not really know plus it was at my home and she acted as if she really did not care.

She later called me to apologize for her hitting her son and tried to lie to me saying it was the first time and she did not know why she had done it. However, in fact I had seen her do it two other times to him but at her home. I am angered even more by her denial of her behaviors towards her child and her belief in her innocence as she reminds me so much of my mother and my ex husband who belied his own lies once he told them. I am also angered by my mental health workers lack of action at this other clients abusive behavior in front of her towards her child and it feels just as it felt when I was younger and my mother told everyone what was going on and they listened and did not look at the signs of my behavior and instead just listened to my mother’s manipulative words. The worker believes this person is naive and innocence and easily taken advantage of and manipulated when in fact she is the manipulative, takes advantage of, devious, lying, person that she has people believing happens to her so often as she uses marijuana more and more and cares less and less about her child. Her life is falling apart quickly and seems to be going down the drain fast but yet I cannot stop it. I cannot do anything about it as she is in denial and she is lying to herself and everyone around her. She is manipulating her son, her workers, her life, and her child’s life. I cannot change her, I cannot change the workers in her or her child’s life, and I cannot change the system. Nevertheless, I must change my own stress, reaction, and how I cope with all this as it is destroying me more and more. I become angrier each encounter I experience and it seems to get worse than the one before.

“So Called Mother/Grandmother”

Why cant I be loved like the rest of them. Why couldnt my kids be loved like the rest of their kids. Why is it you let my kids be thrown to the wolves but yet savior the others. What is wrong with me. what was wrong with my kids. I know what you used to claim “I am not watching them they scream from the time you leave to the time you come back” but that was a reason for you not to love them as much as you the rest in your life now. But yet the ones now scream and you deal with it but could not deal with mine. Guess cause they were mine they got treated with the hate you had for me my whole life and so the cycle continued on…

this weekends failure at ending life

so this weekend I had another failed attempt at ending my life and though supposedly came close to succeeding I obviously failed with much regret though some insight into things. I am not wanted even by the man upstairs. he never even showed up for me.  My family pretended to care so much in a crisis and then turn right back around and the very things that trigger me into feeling unloved, hated, uncared for, and that I have no reason to live. Wow what a show they put on, I guess and harassing the doctors and all and then blowing up my brother who lives here phone and then calling my mental health support worker also. Needless to say yesterday I was glad I survived and today I am very disappointed I failed. I layed there on my bed wondering if my life will ever end or ever get better. I layed there wonder what it is that I can do to improve my quality of life and how can i do it without needing to rely on anyone as someone is bound to let you down at some point or another even if unintentional. But I came to the conclusion that though some people may be capable of doing it I am a needy person and at some points feel like I seek child like emotional attachments and so I need people in my life to fulfill the little child in me that never seemed to have gotten what she needed growing up and now still cannot get it from the one who should have given it to her back then.

and so I am coming into some rocky emotional days I guess need to expect myself to just be and go through them without acting on them or entertaining them. I need to experience all the emotions from this failed attempt and get through this. it is hard to explain and hard to express but i will do it and get through it.

My Downfall

So I am beginning to have a downfall as the day gets closer. My thoughts are getting more focused on negativity and the positivity I am losing sight of. It is almost gone. i have been trying to keep myself busy and help others in my life but that has only made me more of a failure as everything I tell them I have been told and though the stuff I am saying to them is the right things to say and I am not just saying them for that reason I am saying them because I believe they are true for them but i cannot seem to get past the part where these things are right for others but not for me. Where others deserve to be cared about, loved, and need hope and should not kill themselves as there are many reasons they should not end their lives but for me there are many more reasons why people are better off with out me. There are many more reasons why I should end my life such as all the troubles I have endowed to my children through genetics and also through the neglect they endured the early years before being taking from me. The promise I made to them to go with the social workers and behave and I promised them I would get them back. But did  truly fight? NO! I gave up in reality… I quit. I am a quitter. If I had fought I would have won and got them back and gave them the life they deserved. The life I always said my kids would have. A life unfull of chaos, domestic abuse, trauma, abandonment, hurt, shame, pain, guilt, loss, instability, and abuse. These as I was growing up feeling, experiencing, and witnessing I swore my children would never go through and I would never put them through but yet my kids did and it was because of me they had to go through it. It was because I was weak and unable to stand up for them and what I believed that they should never experience. My kids are better off if I am dead before they come searching for me. I have been taking my medications but have decided to stop because the more I take on a daily basis the less I have for the final day.