Education And Debate

Controversies in Management: Better treatment of mental illness is more appropriate aim

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6958.860 (Published 01 October 1994) Cite this as: BMJ 1994;309:860
  1. G Wilkinson
  1. London Hospital Medical College, London E1 2AD.

    Whensoever any affliction assails me, mee thinks I have the keyes of my prison in mine owne hand, and no remedy presents it selfe so soone to my heart, as mine own sword

    It seems unlikely that suicide can be prevented easily by medical means. Non-medical considerations are much more important, including questions of moral philosophy2,3 and sociopolitical matters.

    Although ancient moral arguments exist against suicide, it is difficult to resist the conclusion that suicide is not morally wrong. Indeed, suicide may be rational. So if someone is suicidal to what extent are doctors obliged to do something about it? The law is clear on one issue: that we should not assist people to commit suicide. Other concerns are less clear. If we provide the means for suicide, having fully informed the patient of the likely effects, we face a potential legal hazard. While we have a duty of care for people who are suicidal such people cannot expect unlimited professional advice and help. How long should doctors have the power to keep suicidal people alive against their will?

    Suicide cannot be predicted or prevented reliably

    The most important risk factor for suicide seems to be mental illness, but this knowledge has had little impact on our ability to predict …

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