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Reasoning for autonomous suicide? A qualitative approach to pre-suicidal decision-making

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  • Mrozynski, Hannah
  • Kuhn, Eva

Abstract

The article presents empirical data concerning the meaning of freedom and autonomy in the emotional-cognitive processes that govern pre-suicidal decision-making. The data is derived from a qualitative interview study conducted between December 2012 and July 2014 on an intensive care unit in Germany. Twelve patients (three male, nine female; seven with pre-diagnosed mental illness) who had attempted suicide by intoxication were included. The narrative biographical approach chosen allows to capture the individuals' experiences preceding their decisions for suicide and provides insights into the biographical contexts of their decisions. Most strikingly, the narratives underline the essential importance of interpersonal relationships as well as an ambivalent reciprocity of cognitive and emotional processes in pre-suicidal reasoning, while ideas of autonomy and decision-making capacity traditionally address rational deliberation. This divergence between patients’ subjective perceptions and scholarly conceptualisations of autonomous suicide is in line with increasing criticism of conventional approaches, given that they ignore essential elements of human existence, such as values, emotions, and social interdependence. The empirical findings suggest moving beyond the idea of autonomous decision-making for suicide as a rational procedure and instead conceptualise the pre-suicidal decision-making process as a highly emotional phenomenon within a relational context. Acknowledging that suicidality is not only linked to cognitive considerations but also intertwined with or predominantly controlled by emotional dimensions, such as despair, crisis, and marginalisation, we argue that further evaluation tools are required to address suicidality in all its facets. In moving beyond the mere consideration of cognitive functions, this approach is particularly suitable for representing the reality of persons with mental illness. This provides urgently needed guidance for clinical practice, considering that the latest German jurisdiction on physician-assisted suicide holds that the right to a self-determined death cannot be refused unless an acute psychiatric condition directly caused the suicide wish.

Suggested Citation

  • Mrozynski, Hannah & Kuhn, Eva, 2022. "Reasoning for autonomous suicide? A qualitative approach to pre-suicidal decision-making," Social Science & Medicine, Elsevier, vol. 296(C).
  • Handle: RePEc:eee:socmed:v:296:y:2022:i:c:s0277953622000673
    DOI: 10.1016/j.socscimed.2022.114764
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    References listed on IDEAS

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    1. Yip, Paul S.F. & Yousuf, Saman & Chan, Chee Hon & Yung, Tiffany & Wu, Kevin C.-C., 2015. "The roles of culture and gender in the relationship between divorce and suicide risk: A meta-analysis," Social Science & Medicine, Elsevier, vol. 128(C), pages 87-94.
    2. van Wijngaarden, Els & Merzel, Michal & van den Berg, Vera & Zomers, Margot & Hartog, Iris & Leget, Carlo, 2021. "Still ready to give up on life? A longitudinal phenomenological study into wishes to die among older adults," Social Science & Medicine, Elsevier, vol. 284(C).
    3. van Wijngaarden, Els & Leget, Carlo & Goossensen, Anne, 2015. "Ready to give up on life: The lived experience of elderly people who feel life is completed and no longer worth living," Social Science & Medicine, Elsevier, vol. 138(C), pages 257-264.
    4. Benson, Outi & Gibson, Susanne & Boden, Zoë V.R. & Owen, Gareth, 2016. "Exhausted without trust and inherent worth: A model of the suicide process based on experiential accounts," Social Science & Medicine, Elsevier, vol. 163(C), pages 126-134.
    5. Oliffe, John L. & Broom, Alex & Rossnagel, Emma & Kelly, Mary T. & Affleck, William & Rice, Simon M., 2020. "Help-seeking prior to male suicide: Bereaved men perspectives," Social Science & Medicine, Elsevier, vol. 261(C).
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    1. Gutin, Iliya & Copeland, William & Godwin, Jennifer & Mullan Harris, Kathleen & Shanahan, Lilly & Gaydosh, Lauren, 2023. "Defining despair: Assessing the multidimensionality of despair and its association with suicidality and substance use in early to middle adulthood," Social Science & Medicine, Elsevier, vol. 320(C).

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