Suicide is a common and difficult problem in all societies. Many studies have shown that pain and depression are potential risk factors for suicidal risk in medical patients. Acute changes in medical condition and loss of physical function have also been identified as risk factors, as have agitation and readily available lethal means in this population.
The interface of suicide and euthanasia in medical patients is an area where the attitudes of physicians, and especially psychiatrists are of great importance. One study compared the attitudes of psychiatrists in Japan and the United States in order to investigate their ideas on whether patients in general medical hospitals who have a desire to die should be allowed to, or assisted in this regard, and whether they require psychiatric evaluation and intervention, and the cultural influences on these attitudes.
Japanese and American general hospital psychiatrists' attitudes towards the reasonability of suicide, physician assisted suicide, and removal of life supports under various medical and psychosocial situations were compared. Seventy-two American and sixty-two Japanese psychiatrist's data was collected using the Suicidal Attitudes Inventory (SAI).
The majority of both American and Japanese psychiatrists agreed that there may be times when suicidal ideation, or completed suicide in medical-surgical patients could be reasonable. Significantly more Japanese psychiatrists responded with some agreement to the reasonability of suicide when one is unable to fulfill social role expectations, and had more concern about causing suicidal ideation by informing terminal patients of their diagnosis.
Proper use of antidepressants in appropriate suicidal patients is also necessary to consider. The status of antidepressants in Japan that are approved by the Japanese Authorities is an issue that needs to be followed as it has traditionally lagged far behind the West.
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“However great a man’s fear of life, suicide remains the courageous act, the clear-headed act of a mathematician. The suicide has judged by the laws of chance—so many odds against one that to live will be more miserable than to die. His sense of mathematics is greater than his sense of survival. But think how a sense of survival must clamour to be heard at the last moment, what excuses it must present of a totally unscientific nature.”
—Graham Greene (1904–1991)
“If science ever gets to the bottom of Voodoo in Haiti and Africa, it will be found that some important medical secrets, still unknown to medical science, give it its power, rather than the gestures of ceremony.”
—Zora Neale Hurston (1891–1960)
“A pragmatic race, the Japanese appear to have decided long ago that the only reason for drinking alcohol is to become intoxicated and therefore drink only when they wish to be drunk.
So I went out into the night and the neon and let the crowd pull me along, walking blind, willing myself to be just a segment of that mass organism, just one more drifting chip of consciousness under the geodesics.”
—William Gibson (b. 1948)
“Americans are overreaching; overreaching is the most admirable and most American of the many American excesses.”
—George F. Will (b. 1941)
“A psychiatrist is a man who goes to the Folies-Bergère and looks at the audience.”
—Mervyn, Bishop Stockwood (b. 1913)
“Rarely do American parents deliberately teach their children to hate members of another racial, religious, or nationality group. Many parents, however, communicate the prevailing racial attitudes to their children in subtle and sometimes unconscious ways.”
—Kenneth MacKenzie Clark (20th century)