Table 7. Suggested Questions for the Assessment of Suicidal Symptoms in People With Cancera continued...
Strategies to lessen suicide risk in cancer patients include the following:
- Use medications that work rapidly to alleviate distress (e.g., a benzodiazepine for anxiety or a stimulant for fatigue) while waiting for the clinical effects from antidepressant therapy.
- Pay scrupulous attention to symptom management.
- Limit access as appropriate to quantities of medications that are lethal in overdose.
- Maintain frequent contact with and closely observe the patient.
- Avoid having the patient spend long periods of time alone.
- Mobilize support for the patient.
- Carefully assess the patient's psychological responses at each crisis point over the course of the disease.
Effect on Family and Health Care Providers
When suicide complicates bereavement, the loss can be especially difficult for survivors. A pattern of reactions that includes feelings of abandonment, rejection, anger, relief, guilt, responsibility, denial, identification, and shame may occur. This pattern is modified by such factors as the nature and intensity of the relationship, the nature of the suicide, the deceased person's age and physical condition, the perceived support network, and the survivor's coping skills and cultural/religious background. Assisting survivors through the bereavement period is important. Mutual support groups are helpful in reducing isolation, providing opportunities for venting feelings, and finding ways to cope with the aftermath of suicide. (Refer to the PDQ summary on Grief, Bereavement, and Coping With Loss for further information.)
Staff reactions to the suicide of a patient are similar to those seen in family members, although staff often do not feel that they have the same right to express their feelings. The suicide of a patient may lead a staff member to question his or her professional judgment. It is often helpful for the staff to conduct a psychological autopsy in an attempt to understand why and how the suicide happened, signs and symptoms of risk, and how routines might be altered to prevent similar problems in the future.
Assisted Dying, Euthanasia, and Decisions Regarding End of Life
The principle of respecting and promoting patient autonomy has been one of the driving forces behind the hospice movement and right-to-die issues that range from honoring living wills to promoting euthanasia. These issues can create a conflict between patient autonomy and the physician's obligation to beneficence.