Duty of care

[_Patient_]

Content/trigger warning

It's nice when humans care for each other. I appreciate every hug and gentle word when I've been at my worst, and the sense of camaraderie, of family, that I feel with my loved ones has pulled me back from the brink more than once. But this insistence that suicide must always be resisted (ostensibly because "it will get better"), is a narrow-minded throwback to moral precepts that don't always apply today - and is ignorant and damaging, in my opinion.

Is it really so unbelievable to think that death might be the lesser of two evils? The persistence of the death penalty across cultures and millennia, and the increasing acceptability of euthanasia today, both suggest that human societies broadly do allow some breathing room for edge cases. So why not me?

Moral invalidation of suicide means I can't talk to my friends or family about it, because instead of having a meaningful, fruitful conversation about my future, they're limited to hugs and discouragement - which is to say, they're required to insist that I go on suffering, because opting out cannot possibly be right. Duty of care properly discharged, then.

It means that I can't transition out of my professional duties in a responsible way - I'm just not going to turn up one day and they'll have to deal with it. It means can't make preparations in the open, working to minimise trauma to my loved ones, or secure humane methods (in behalf of my own duty of care to myself). I have to keep it all secret like some kind of heretic, and then spring it on them in one foul, shocking moment that will scar them for life, hoping that a note will help them. I have to die a criminal, in uncontrolled conditions, and leave a trail of destruction in my wake. How is that the moral way?

[Jynx]

Hi @_Patient_, welcome to the forums. I can hear how much this has been impacting you, and just wanted to offer my thoughts. 

I agree with you wholly, that the incredible stigma surrounding suicide makes it a taboo topic, which makes it that much harder to feel like we can open up about how much it is impacting us. I'm not here to say that I think suicide is the correct choice, but having been on both sides of the sitch (I used to live with constant suicide ideation on one side, and now working in mental health and being bound by Duty of Care on the other), I think you've raised some very good points. Kinda reminds me of this analogy I heard once, to explain why someone might make an attempt: 

Imagine you're in a burning building. Your choices are to stay, and die very slowly and painfully, or make the jump for something quick. Only thing is, no one else seems to be able to see the flames, and will keep insisting you stay inside. 

You're right, euthanasia is becoming a more accepted practice - and for some people, it might be the most humane option. For example my dad, he's got late stage Parkinson's and his capacity to do anything fulfilling, or even halfway entertaining, has been reduced to almost zero. If he told me that he wanted to opt for euthanasia I'd support him wholly - which raises another point: I believe in sovreignty over mind and body, a.k.a. no one else gets to make that decision for you.

Having said all of that though, I will also fight tooth and nail to encourage folks to go on living, where there is even a sliver of hope that things can improve. Having recovered from SI myself, and knowing that at least half a dozen of my close friends wouldn't be here if they had succeeded in their attempts, I know that recovery is possible - it just all comes back to a person's individual situation. 

I am really sorry that this stigma and taboo has meant that you're unable to have any sort of meaningful conversation about it with the people in your life. I'm wondering if maybe that's something this community could offer you: a safe space to be able to express yourself. It would have to be within our Guidelines of course, and we do have guides for posting safely about suicide that can help. But yeah, you deserve to be heard, and treated with compassion, not pushed away because it's 'too scary to think about' or whatever reasons people tend to have. 

Thank you for sharing, and I hope that the forums can provide you with what you need 💜

[_Patient_]

Hi @Jynx (funny word, three dotted letters in a row).

Thank you for sharing. I appreciate your time and insight, and openness.

> I will also fight tooth and nail to encourage folks to go on living, where there is even a sliver of hope that things can improve.

Why though? If, on the balance of probabilities, the situation really won't improve, then (I think) it's rational to remove oneself from that situation, and condemnation to a kind of earthly purgatory to remain because others invest you with hope, or duty, or fear or whatever else, that don't reflect your actual reality. That made sense when I was 20, but by now I think the unhealthy, self-destructive modes of thought (not to mention the actual electrochemical mayhem in my brain) are so intractable that the amount of work required to - maybe - tip the scales back in favour of joy and purpose is too remote to be worth the attempt. There's hope that I'll find a somewhat balanced, plodding existence that doesn't upset people, but a meaningful happiness is now out of reach. Is that worth fighting for, really?

Why, though?

[Jynx]

Hmmm... perhaps because the way I 'fight' is very different to the way our mh system is currently set up to support people in crisis @_Patient_. In our current system, people who are high risk for suicide are often carted off to hospital (against their wishes) to ensure they are 'stable' - then sent right back home to where all their misery was compounding in the first place. A lot of the time, there's little to no aftercare or continuity of care - not to the levels that a person in such an intensely vulnerable state would require. 

I also fight because, as I said earlier, I have witnessed enough evidence of the possibility of a full and enjoyable life post-attempt, that I will continue to hold onto that hope for others.  You're right in pointing out that it's a monumental amount of work. However, knowing what we know about neuroplasticity, it's not impossible. 

I will acknowledge that there may be other factors that no amount of hope can change (e.g. chronic illness), which is why I do think that euthaniasia ought to be a viable option for people. However, for me personally, I will never give up hope that things can change for people. I'd never force that upon someone though, or try to tell them that I know better than them - cos agency is also something I value highly. 

So, do I believe in hope for you, and would I fight for you? In a heartbeat. But, I also would not guilt trip you, undermine you, or tell you that you're straight up wrong for thinking this way. My goal as a therapist/peer support worker is never to 'save' people, but perhaps that is not as common an approach in the MH world. 

[_Patient_]

Hi @Jynx,

Thank you. I respect your perspective on this and I appreciate the time you've taken to share it with me. 

I've been putting in the work for 30 years, I feel justified in opting out at this point. I'm just indignant that there aren't less shitty options available. Plus complaining about stuff is 80% of my personality. I'm really good at it now.

Let's hope the VAD board is as open-minded as you.