For more mental health resources, see our National Helpline Database. Physician-assisted death for those with a terminal illness is fairly widely supported. A 2018 Gallup poll found that more than 70 percent of those surveyed were in favor of a physician ending a terminally ill person’s life through lethal means. Among those who are terminally ill,more than three-quarters of people deal with depression, and nearly half (45 percent) experience suicidal ideation, for reasons including pain, fear of future pain, loss of control and a feeling that life is over.
Risk Factors
Largely, the conversations around rational suicide and physician assisted death center around elderly, as suicide risk is higher in this population, but there are several other risk factors, including chronic illness and cancer.
Advanced Age
Age is one of the top risk factors for suicide. Although most suicide prevention programs focus on younger people, the risk for both elderly people taking suicidal actions and completing suicide are higher than in other groups.
Chronic Pain
Chronic pain may be one of the risk factors for suicide since many dealing with chronic pain feel helpless or hopeless and want to escape the pain. This group may also engage in more pain-related catastrophizing or avoidance. People with chronic pain are between two and three times as likely to die by suicide or report suicide related-behaviors. Migraines, psychogenic pain, and back pain were associated with increased likelihood of suicide completion. Because of these risk factors, the World Health Organization recommends clinical assessment of suicidal behaviors in anyone with chronic pain over the age of 10.
Cancer
Having cancer puts one at high risk for suicide,especially in particularly aggressive cancers like stomach or pancreatic cancer. The suicide rate for this population is nearly double that of the general public.
Mental Health Conditions
For patients with physical health concerns that are hastening their death, support is generally fairly high for rational suicide. However, mental health concerns are different. Those who believe that suicide cannot be rational for those with mental health issues argue that suicidality may be a part of the condition. On the other hand, those who believe in rational suicide for mental illness argue that suicide in physical health conditions may also be influenced by the disease. There is a bit more support for people with serious mental health conditions such as schizophrenia, where it is recognized that there is a much lower quality of life, including difficult side effects from medication, intense psychological suffering, physical functioning and a lack of economic stability.
Psychotherapy and Rational Suicide
Therapists were most accepting of people who chose to end their lives because of a terminal illness. Eighty-eight percent of those surveyed believed that suicide was rational if the following conditions were met:
The person considering suicide has an “unremitting hopeless condition,” including terminal illnesses, severe physical or psychological pain, and physically or mentally debilitating/deteriorating conditions.The decision is made by the individual—they are not coerced by others.The person has engaged in a thorough decision-making process, including consulting with a mental health and medical professional, considering the impact on significant others, consideration of alternatives, and consideration of whether suicide is aligned with one’s values.
There are various governing bodies and associations that oversee each type of mental health professional (e.g., the American Counseling Association for Licensed Mental Health Counselors and; the National Association of Social Workers for LCSWs). In typical psychotherapy situations, a therapist would be obligated to take reasonable measures to prevent the suicide. States with physician-assisted death laws or therapists protected by ethical codes allow them to address the end-of-life concerns and their autonomy instead. In these situations, therapists may explore grief, spiritual issues and self-determination.
Existential Perspective & Therapy
From a holistic existential therapy standpoint, the idea of existential coherence (how someone’s true self is or isn’t able to be present in the world) is explored.
Physician-Assisted Death
If one is dealing with a terminal illness, certain states do allow for physician-assisted death, although they have different regulations. Below are the states that allow for physician-assisted death, which is defined as a physician giving a person the means/medication to die rather than the physician administering it.
CaliforniaColoradoDistrict of ColumbiaHawaiiMaineMontanaNew JerseyOregonVermontWashington
A Word From Verywell
We recognize the validity of deep suffering, both mentally and physically, and urge anyone in pain to talk to a medical and/or mental health professional. You do not have to go through any pain alone, and people are here to care for you and support your needs.
The patient is expected to die (usually of a terminal illness) within a certain period of time (generally six months)The patient must make a combination of written and oral requests and undergo waiting periods (typically about 15 days between oral requests)The patient must be older than 18 years of age The patient must be able to make the decision on their own—mental screening may applyThe patient must be able to self-administer the drugThe patient’s physician must agree/approve
