Suicide is an absolutely horrible phenomenon. It destroys families and forever leaves survivors on an elusive search for why it happened. Suicide is often viewed as a very selfish act, yet I believe that in many cases those who do it truly cannot endure the emotional pain any longer and believe that they are out of options. When I was a young adult, an extended family member committed suicide. During my career I have lost a small number of patients to suicide as well. These were all very tragic experiences.

In the United States, mental health professionals have a legal responsibility to take action when our patients appear to be at risk for harming themselves. It is not possible for us to accurately predict when a person is going to commit suicide, but we are expected to assess for and document suicide risk factors. If necessary, we may have to call police or take other action to have patients involuntarily admitted to an inpatient psychiatric unit.

Involuntary commitment is a very controversial topic. What usually does not get discussed, though, is the fact that many mental health professionals, including myself, are often very uncomfortable being placed in the role of essentially being responsible for someone else’s behavior.

Although the majority of people who attempt or commit suicide suffer from mental illness, some do not. For those who do, some may be psychotic and therefore completely out of touch with reality or so clinically depressed that they have lost all hope.

In the latter two examples, the patients likely have treatable conditions, and once treated, they may change their minds about wanting to die. Even when I believe a patient simply wants to die and has “legitimate” reasons for feeling this way, I always try to dissuade them from harming themselves. I have not, and will never, shirk my professional duties.

From a philosophic standpoint, it makes perfect sense to me that mental health professionals should do all that we can to help people however we can. What I find rather odd, though, is that people in our culture do not have a right under any circumstances to end their own lives. I am not in favor of physician-assisted suicide or suicide at all for that matter. But, on a human-to-human level, who the heck am I, anyway, to tell someone that they can’t end it all if they choose to? I’ve never been suicidal, but likewise, who is anyone else to tell me I cannot do it either?

I understand firsthand that if affects people other than the one doing it, but at some level, at least, isn’t that personal choice? And, if it isn’t, then who, if anyone, should be held responsible if someone chooses to end his or her own life – psychiatrists, psychologists, therapists, primary care physicians, family, friends? In various life situations, Western society is great at assigning blame when there is a bad outcome, but I rarely hear people talk about free will.

I’m really curious what people think about this issue. I don’t hear it discussed often, but I believe it should be.