Rational Suicide in the Elderly - Clinical, Ethical, and Sociocultural Aspects

von: Robert. E McCue, Meera Balasubramaniam

Springer-Verlag, 2016

ISBN: 9783319326726

Sprache: Englisch

229 Seiten, Download: 5717 KB

Format: PDF, auch als Online-Lesen

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Rational Suicide in the Elderly - Clinical, Ethical, and Sociocultural Aspects

	Contents	5
	Contributors	7
	Introduction	9
	1: Can Suicide in the Elderly Be Rational?	12
	1.1 Introduction	12
	1.2 Suicide, Mental Illness, and Rationality	14
	1.3 The Meanings of Suicide	20
	1.4 The Paradigm of Terminal Illness Making Suicide Rational	22
	1.5 Assessing Rationality in the Elderly	24
	1.6 Cases and Commentary	27
	References	31
	2: Would This Be Rational Suicide?	33
	2.1 Introduction to Mr. D	33
	2.2 Criterion 1: The Ability to Demonstrate Rationality	35
	2.3 Criterion 2: Realistic Information and Judgment About the Lifeworld	36
	2.4 Criterion 3: Lucid State of Mind, Intelligible Emotion, and Authentic Will	37
	2.5 Criterion 4: Congruence with Fundamental Values and Critical Interests	38
	2.6 Conclusion	39
	References	41
	3: Rational Suicide and the Law	43
	3.1 Introduction	43
	3.2 Legal Background	43
	3.3 Assisting a Suicide	44
	3.4 Legalized Physician-Assisted Suicide	46
	3.5 Civil Liability and Treating the Suicidal	48
	References	53
	4: Refractory Depression and the Right to Terminate Active Treatment	55
	4.1 Introduction	55
	4.2 Treatment-Resistant Depression (TRD)	56
	4.3 Terminal Depression and the Case of Mr. A	57
	4.4 Biological Substrates of TRD	60
	4.5 Novel Antidepressant Approaches to TRD	61
	4.6 Decision-Making Capacity	63
	4.7 End-of-Life Decisions in Psychiatric Patients in Europe	65
	4.8 Discussion	66
	References	67
	5: A Psychological History of Ageism and Its Implications for Elder Suicide	72
	5.1 Traditional History of Ageism: The Lens of Social Gerontology	74
	5.2 Psychological History of Ageism	75
	5.2.1 Ageism as Rooted in the Fear of Death	75
	5.2.2 Ageism as Rooted in Perception	76
	5.2.3 Ageism as Rooted in How We Think	77
	5.3 Implications for Elder Suicide	78
	5.3.1 A Brief History of Attitudes Toward Suicide	79
	5.3.2 Elder Suicide in Our Contemporary World	79
	5.4 Conclusion	81
	5.5 Notes	81
	References	82
	6: Rational Suicide in the Elderly: Anthropological Perspectives	84
	6.1 Introduction	84
	6.2 Suicide and Culture	85
	6.3 Historical Perspectives	86
	6.4 Anthropology and Rational Suicide	87
	6.5 Conclusion	90
	References	91
	7: Life’s Meaning and Late Life Rational Suicide	92
	7.1 Introduction	92
	7.2 Two Questions About the Meaning of Life	94
	7.3 Can a Human Life Have Meaning?	95
	7.4 What Makes a Human Life Meaningful?	100
	7.5 Life’s Meaning and Suicide	103
	7.6 Conclusion	105
	References	106
	8: Baby Boomers and Rational Suicide	108
	8.1 Introduction	108
	8.2 What Is so Special About the Baby Boomers?	109
	8.3 Attitudes Toward Youth and Aging	110
	8.4 Baby Boomers and Death	112
	8.5 Baby Boomers and Suicide Risk in Late Life	113
	8.5.1 Social Isolation	113
	8.5.2 Substance Use	113
	8.5.3 Chronic Illnesses	114
	8.5.4 Financial Difficulties	115
	8.6 Conclusions	116
	References	117
	9: Who Are the Elderly Who Want to End Their Lives?	121
	9.1 Definition of Rational Suicide	122
	9.2 Epidemiology	123
	9.3 Age and Ageing	123
	9.4 Gender	125
	9.5 Marital Status	125
	9.6 Ethnicity	126
	9.7 Religion	126
	9.8 Spirituality	127
	9.9 Education	128
	9.10 Social Support	128
	9.11 Physical Problems and Ill Health	128
	9.11.1 Cancer/Malignancy	128
	9.11.2 Pain	129
	9.11.3 Alzheimer’s Disease/Cognitive Impairment	129
	9.11.4 Sensory Impairment	130
	9.12 Depression and Euthanasia/PAS	130
	9.12.1 Depression/Depressive Symptoms in the Context of Medical Problems	130
	9.12.2 Depression in the Context of Terminal Illness	130
	9.12.3 Depression and Stability of Attitudes Towards Euthanasia/PAS	131
	9.13 Personality Factors	131
	9.14 Psychological Factors: Life Satisfaction and Burden on Others	132
	9.15 Conclusions	133
	References	134
	10: Psychological Issues in Late-Life Suicide	137
	10.1 Introduction	137
	10.2 Psychological Theories of Suicide	138
	10.3 Rational Suicide Risk Assessment	139
	10.3.1 Traditional Suicide Risk Assessment	139
	10.3.2 Motivational Interviewing	140
	10.3.3 Self-Determination Theory	141
	10.3.4 Collaborative Assessment and Management of Suicidality (CAMS)	142
	10.3.5 Structured Assessments	142
	10.3.6 Medical Decision-Making Capacity	143
	10.4 Lessons from Psycho-Oncology	143
	10.4.1 Desire for Hastened Death	144
	10.4.2 Hopelessness	145
	10.4.3 Burdensomeness, Helplessness, and Loss of Control	146
	10.4.4 Social Support	147
	10.4.5 Existential Distress	147
	10.5 Practice Guidelines	148
	10.5.1 Interdisciplinary Intervention	150
	10.6 Conclusion	150
	References	150
	11: A Psychodynamic Perspective on Suicidal Desire in the Elderly	156
	11.1 The Case of Ms. A	156
	11.2 Theories of Suicide: Freud and Beyond	157
	11.3 Revisiting the Case of Ms. A	160
	11.4 Conclusion	164
	References	164
	12: Impact of Psychotherapy on Rational Suicide	166
	12.1 Introduction	166
	12.2 Motivational Interviewing	168
	12.2.1 Empirical Research	170
	12.2.2 Application to Rational Suicide	170
	12.3 Safety Planning	171
	12.3.1 Empirical Research	172
	12.3.2 Application to Rational Suicide	172
	12.4 Cognitive-Behavioral Therapy	173
	12.4.1 Empirical Research	173
	12.4.2 Application to Rational Suicide	174
	12.5 Dialectical Behavior Therapy	175
	12.5.1 Empirical Research	176
	12.5.2 Application to Rational Suicide	176
	12.6 Mindfulness and Acceptance	176
	12.6.1 Empirical Research	178
	12.6.2 Application to Rational Suicide	178
	12.7 Existential Therapies	179
	12.7.1 Empirical Research	179
	12.7.2 Application to Rational Suicide	180
	12.8 Psychodynamic Therapy	181
	12.8.1 Empirical Research	181
	12.8.2 Application to Rational Suicide	182
	12.9 Interdisciplinary Collaboration	182
	12.10 Practice Guidelines	183
	12.10.1 Prevent Impulsive Behavior	183
	12.10.2 Nonjudgmentally Explore Suicidality and Values	183
	12.10.3 Cognitive-Behavioral and Mindfulness Skills Can Be Helpful	184
	12.10.4 Existential Concerns are Important	184
	12.10.5 Collaboration with Patients’ Systems Is Critical	185
	12.10.6 Some Things Are Not Recommended	185
	12.10.7 Be Mindful of Own Values	185
	12.11 Conclusions	186
	References	186
	13: Spirituality, Religion, and Rational Suicide	193
	13.1 Introduction	193
	13.2 Engaging Religion and Spirituality: The FICA Spiritual History Tool	194
	13.3 Religion, Spirituality, and Rational Suicide, with Focus on Christianity	195
	13.4 Historical Christian Perspectives on Suicide	196
	13.5 Contemporary Christian Perspectives on Suicide	197
	13.6 Two Affirmations Behind Modern Christian Objections to Rational Suicide	198
	13.6.1 Affirmation 1: “Autonomy” and “Rationality” Are Modern Constructions	198
	13.6.2 Affirmation 2: Vulnerability Is Normative, and Christians Belong to God and to Each Other	199
	13.7 Two Christian Objections to Rational Suicide	201
	13.7.1 Objection 1. Suicide Addresses Suffering by Eliminating the Sufferer	201
	13.7.2 Objection 2. Suicide Diminishes the Role of Community in Bearing the Burdens, and Vulnerability, of Those Who Suffer	203
	13.8 Conclusions: Practical Recommendations for Clinicians	206
	References	207
	14: Classic Psychedelics and Rational Suicide in the Elderly: Exploring the Potential Utility of a Reemerging Treatment Paradigm	209
	14.1 Introduction	209
	14.2 Sociopolitical History of Classic Psychedelics	209
	14.3 Empirical Findings with Classic Psychedelics: Implications for Rational Suicide	211
	14.4 Conclusion	214
	References	214
	15: Epilogue	217
	Index	224

Rational Suicide in the Elderly - Clinical, Ethical, and Sociocultural Aspects

von: Robert. E McCue, Meera Balasubramaniam

Rational Suicide in the Elderly - Clinical, Ethical, and Sociocultural Aspects

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