Cancer causes a series of physical, psychological, social and spiritual symptoms that lead to great discomfort. Some patients may attempt suicide to end their suffering. When managing these situations, several factors must be taken into account: the reasons, the decision-making capacity, the implications for family members and health professionals, etc. This article reflects on suicide in people with cancer.
Thoughts of death or suicide are ideas in which a person considers the possibility of causing their own death. These thoughts do not imply a suicidal attempt or act. The suicide attempt is the premeditated action to end one’s life voluntarily. The suicidal act is the suicide attempt with which the person obtains the desired result.
In the general population, in 2012, suicide was the cause of 1.4% of all deaths worldwide. The suicide rate stands at 11.6 per 100,000 inhabitants. The vast majority of people who commit suicide have a mental disorder.
There are some false myths surrounding suicide that it is important to correct. Among these, the erroneous ideas such as whoever wants to commit suicide does not warn, that talking about suicide leads to committing it, or that suicide is a show of cowardice or courage.
Suicide figures in people with cancer are very different. Some studies place it at 0.03% in patients within the first year after diagnosis. Other investigations speak of 8-10% of cancer patients at the end of life who would have thoughts of committing suicide or wish to die.
Ethical and legal aspects of suicide in psycho-oncology
Suicide is not illegal. Neither is the attempt, even if it is unsuccessful. But yes, inducing the suicide of another person or collaborating in an autolytic act are illegal.
And why is it important to talk about the legal aspects?
Because the issue of suicide in people with cancer is closely linked to euthanasia. Euthanasia is the medical act of causing the death of a person with a highly disabling disease and with a short life prognosis, with very intense suffering that is not relieved by established treatments, and who has repeatedly asked to die and with the full ability to reason.
Euthanasia is not allowed in our country either. The social debate is still open and the legislator does not show sufficient interest in addressing this debate. For this reason, when a patient says that he/she wants to commit suicide, or asks to be euthanized, a conflict appears between the four principles of bioethics.
These are the principles that a health professional must respect when dealing with their patients:
Principle of non-maleficence:
Do no harm to the patient. If hurting him/her is unavoidable, do as little as possible to get the most benefits.
Principle of beneficence:
Do good. Try to cure diseases, relieve symptoms and seek the greatest benefit for health.
Principle of justice:
Treat all patients equally, in proportion to the severity of their illness.
Principle of autonomy:
Respect the decisions of the patient, both in relation to the disease and in relation to the treatment.
When a cancer patient expresses the will to commit suicide, the conflict appears between the ethical duty of health professionals to do what they can to avoid it and the principle of autonomy of this patient (who, in theory, should be able to decide on their own body). Which of the two should prevail? Is it reasonable to force the hospitalization of this person to preserve life? Can we “inform” the family, to ask them to remain vigilant, thus breaching the duty of confidentiality with the patient? What if with these measures we can’t avoid it either?
A cancer patient thinks about committing suicide
This is not an article to answer these questions. Suicide in people with cancer is a sensitive enough subject to need to be discussed on an individual level. Each person is a world, and establishing a protocol would fall short. But leaving these questions open doesn’t necessarily have to be a bad thing.
Risk factors for suicide attempt in people with cancer:
- That the patient is male
- Age over 40 years
- Live stressful life events
- Diagnosis of pancreatic cancer or lung cancer
- Complaints about the ineffectiveness of treatment to reduce pain or other symptoms that cause suffering
- Manifestations of depression and hopelessness
- Substance Abuse
- Poor social support
How to address suicide attempts in cancer patients
The cancer patient who wants to commit suicide does NOT want to die. He/She wants to end the suffering, since the treatment to control the symptoms is not working for them.
Any references made by a person with cancer to the wish or intent to commit suicide should be taken seriously and addressed professionally. It is essential to establish a sincere and empathetic dialogue.
It is also important to analyze how to process your suicidal idea: Admit its advantages and disadvantages? Is the decision reasoned, thoughtful and persistent over time? Do they know the consequences of committing suicide and trying to do it without success?
Support of a cancer patient who wants to commit suicide
Suicide in people with cancer does not have death “per se” as its goal. There is no will to stop living. There is a will to stop suffering. Suffering is a central issue, and deserves special attention from professionals. It is the way to look for alternatives: If a way to alleviate suffering can be found, suicide ceases to be “necessary” from the perspective of the patient.
Likewise, we must try to guarantee social and family support when possible, and professional support in all cases. Taking into account that the topography of the idea of committing suicide (intention, moment, method, etc.) may vary over time.
The patient must also be able to participate in decision-making. He deserves to be treated as a unique person, with rights, with motivations, with objectives, with contradictions and with his particular way of seeing the world.
The family may also need support, especially if they are unable to prevent suicide attempts. The family can be provided with resources to manage the situation, and psychological and social support if needed.
