Why the book was written.
The situation in the U.S.: there are more than 80 deaths from
suicide every day, while an estimated 300,000-600,000 people a year
survive suicide attempts. 116,000 are hospitalized; seventeen
percent, some 19,000, of these people are permanently disabled each
year. These numbers refer to acts formally classified as suicides,
but there are also many lifestyle choices that may be called "slow
suicide". 6 pp.
Views concerning suicide have varied over time and culture, ranging
from violent opposition to active encouragement. Chapter two is an
historical sketch of ideas about suicide, from early Egyptian to
the present. Emphasis is on Western (Greek, Roman, Christian,
European) positions. 7 pp.
Three ways to examine suicide are sociology, psychiatry, and
biology. The sociological perspective looks at society's influence
on its members; how do various social conditions (and their
changes) affect suicide rates. The psychiatric approach emphasizes
and examines the individual, and the conflicts within a particular
mind leading to self-destructive behavior. The biological view
sees physical disorders, often a biochemical imbalance, as the
"cause" of suicide and other psycho-pathological problems, like
schizophrenia. 8 pp.
Chapter four cites general reasons described in the suicide
literature; these range from "altruistic" suicide to "an attempt to
manipulate others". There is also a brief discussion of the
conceptual difficulties that arise from such a wide variety of
intents being lumped together as "suicide". 9 pp.
Adolescents attempt suicide roughly ten times as frequently as do
adults, but their fatality rate (per attempt) is about one tenth as
high. This chapter briefly describes some differences between
adult and youth suicides, and describes some international data to
put U.S. statistics into perspective. 6 pp.
"When an old person attempts suicide he almost fully intends to
die." Chapter six describes the high suicide rate among the
elderly, and the reasons cited in the medical literature for these
numbers. 6 pp.
"Are suicidal people crazy?" While schizophrenia and depression
carry a 10-15% lifetime risk of suicide, most people with these
diagnoses do not kill themselves. Suicide is also associated with
physical illness and with alcoholism.
"How would I know if someone close to me was considering suicide?"
The more familiar method consists of sensitivity to various verbal
and behavioral clues; but the fact is, while many people consider,
mention, or threaten suicide, far fewer make a suicide attempt.
Sociological and biological risk factors are an alternative
prediction model. However, using any or all tools, the ability to
identify which individuals will commit suicide remains negligible.
Chapter 8 opens with a brief examination of the circumstances under
which suicide may be the right thing to do. It continues with a
look at suicide intervention. Temporary hospitalization is the most
frequent form of intervention, but it is not clear that long-term
hospitalization is helpful in preventing suicide. 7 pp.
Much of medical practice has shifted from treatment of acute
infectious disease to treatment of chronic or degenerative illness,
such as cancer and stroke. Illness-driven suicide is one of the
consequences of this change. Many physicians feel that euthanasia
and assisted suicide are sometimes appropriate, and in some
circumstances would want it for themselves. 14 pp.
The driving force behind assisted suicide is, in large part, the
failure of the medical system and its practitioners to deal
caringly and compassionately with the dying. 4 pp.
Pain is often treated inadequately and patients' advance directives
are frequently ignored . Attempts to improve the situation have
been largely unsuccessful. Hospice and comfort care are
alternatives to dying in the hospital and/or to suicide in response
to terminal illness. Hospices generally treat patients with skill
and sensitivity, but they are not universally effective, and not
everyone wants a lingering death, even with the best of care. 9 pp.
These documents, while well-intended, are unreliable. This is
partly because end-of-life medical decisions are sometimes too
complicated to be made on the basis of prior legal documents; more
often it is because physicians and hospitals ignore or are unaware
of the patient's advance directives. 17 pp.
"...without knowledge of proper dosages and methods, suicide
attempts are often bungled, leaving the victim worse off than
before." There are two main practical problems with assisted
suicide: (1) in most places it's illegal; (2) in many cases the job
is botched. These are related. Because assisted suicide is
illegal, most practitioners are amateurs with limited knowledge and
no supervision. 8 pp.
Euthanasia has been openly practiced in the Netherlands since 1973.
The Dutch experience has been cited both by proponents and
opponents of euthanasia and assisted suicide; each position is
summarized. 6 pp.
Euthanasia and assisted suicide are not panaceas---people will
still kill themselves on account of present misery; but not over
fears of future helplessness. Improved medical care---and caring---for the dying will decrease the impetus for suicide, assisted or
not. But in the absence of such care, or when it fails, each of us
who so decides should have the option of a chosen death. 11 pp.
Fatalities range from 8 or 9 deaths out of every 10 attempts with
guns, to fewer than one of ten with cuts or with drugs. Hanging,
carbon monoxide, and drowning are also particularly lethal methods,
while most other gases or poisons are substantially less so.
Injury data is both more complex and less available. 10 pp.
"Asphyxia" is any process that cuts off the oxygen supply to the
brain. This includes such seemingly unrelated methods as a plastic
bag over the head, hanging, and carbon monoxide poisoning. Death
occurs within roughly 5-10 minutes after complete asphyxia. Some
of these methods are suitable for suicide; none are appropriate for
a suicidal gesture. 28 pp.
Cutting and stabbing are not common means of suicide in most of the
world; however, around 10 percent of suicidal gestures/attempts are
from wrist cutting. Unlike some all-or-nothing methods cutting and
stabbing can be made about as lethal as you choose to make it, if
you know what you're doing. 22 pp.
Drowning is an effective and quick means of suicide, usually taking
between four and ten minutes. Whether or not it is minimally
traumatic, as some have claimed, is in dispute. It is responsible
for only 1.3% of suicides in the U.S., land of the handgun, but is
much more common in many other parts of the world. It is a
distinctly poor choice for a suicidal gesture. 14 pp.
The focus of this chapter is information on the toxicity and lethal
dose of some commonly used drugs and household chemicals, and is
meant to help (1) those who want to survive a suicidal gesture pick
a relatively safe drug and dose; (2) those who intend to die pick
a drug with a more-or-less acceptable combination of lethality,
speed, and unpleasantness. 41 pp.
Electrocution is another effective, but rarely used, method of
committing suicide. It is not a good choice for a suicidal
gesture. The potentially lethal effects of electricity on the body
include heart stoppage, respiratory failure, and burns. 20 pp.
Shooting yourself is a generally successful---76%-92% mortality
rates are reported---but frequently messy method of suicide.
Suicidal gun wounds to the head tend to be quickly fatal, but there
is a 2-6% survival rate, and these people often have brain damage
and/or disfiguring injuries. Gunshot is a method that can be, and
all-too-often is, used impulsively, and doesn't require much
planning, or time to reflect on other possibilities. 37 pp.
All forms of hanging and strangulation are effective methods of
suicide. Many can be carried out by people with limited physical
abilities and don't require complete suspension. Death occurs
within about 5-10 minutes after complete cutoff of oxygen or
blockage of blood flow to the brain (anoxia). These are highly
lethal methods and cannot be done safely as a suicidal gesture. 35
Hypothermia (low temperature) is an effective, but infrequently
used method of suicide. It is generally a poor choice for a
suicidal gesture, unless one is sure of timely intervention. 19 pp.
Jumps from higher than 150 feet (10-12 stories) over land and 250
feet over water are almost always fatal; however most suicide
attempts are from considerably lower. The consequences of lower
jumps are unpredictable, and permanent injuries, including
paralysis, are common. Jumping is thus a particularly bad choice
for a suicidal gesture. 24 pp.