The Future of Assisted Suicide and Euthanasia provides the most thorough overview of the ethical and legal issues raised by assisted suicide and euthanasia--as well as the most comprehensive argument ...against their legalization--ever published. In clear terms accessible to the general reader, Neil Gorsuch thoroughly assesses the strengths and weaknesses of leading contemporary ethical arguments for assisted suicide and euthanasia. He explores evidence and case histories from the Netherlands and Oregon, where the practices have been legalized. He analyzes libertarian and autonomy-based arguments for legalization as well as the impact of key U.S. Supreme Court decisions on the debate. And he examines the history and evolution of laws and attitudes regarding assisted suicide and euthanasia in American society.
Suicidal behavior in older adults (65 years old and over) is a major public health issue in many countries. Suicide rates increase during the life course and are as high as 48.7/100,000 among older ...white men in the USA. Specific health conditions and stress factors increase the complexity of the explanatory model for suicide in older adults. A PubMed literature search was performed to identify most recent and representative studies on suicide risk factors in older adults. The aim of our narrative review was to provide a critical evaluation of recent findings concerning specific risk factors for suicidal thoughts and behaviors among older people: psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses, and physical and psychological pain. We also aimed to approach the problem of euthanasia or physician-assisted suicide in older adults. Our main findings emphasize the need to integrate specific stress factors, such as feelings of social disconnectedness, neurocognitive impairment or decision making, as well as chronic physical illnesses and disability in suicide models and in suicide prevention programs in older adults. Furthermore, the chronic care model should be adapted for the treatment of older people with long-term conditions in order to improve the treatment of depressive disorders and the prevention of suicidal thoughts and acts.
This open access book focuses on the public health crisis of youth suicide and provides a review of current research and prevention practices. It addresses important topics, including suicide ...epidemiology, suicide risk detection in school and medical settings, critical cultural considerations, and approaches to lethal means safety. This book offers cutting-edge research on emerging discoveries in the neurobiology of suicide, psychopharmacology, and machine learning. It focuses on upstream suicide prevention research methods and details how cost-effective approaches can mitigate youth suicide risk when implemented at a universal level. Chapters discuss critical areas for future research, including how to evaluate the effectiveness of suicide prevention and intervention efforts, increase access to mental health care, and overcome systemic barriers that undermine generalizability of prevention strategies. Finally, this book highlights what is currently working well in youth suicide prevention and, just as important, which areas require more attention and support. Key topics include: The neurobiology of suicide in at-risk children and adolescents. The role of machine learning in youth suicide prevention. Suicide prevention, intervention, and postvention in schools. Suicide risk screening and assessment in medical settings. Culturally informed risk assessment and suicide prevention efforts with minority youth. School mental health partnerships and telehealth models of care in rural communities. Suicide and self-harm prevention and interventions for LGBTQ+ youth. Risk factors associated with suicidal behavior in Black youth. Preventing suicide in youth with autism spectrum disorder (ASD) and intellectual disability (ID). Youth Suicide Prevention and Intervention is a must-have resource for policy makers and related professionals, graduate students, and researchers in child and school psychology, family studies, public health, social work, law/criminal justice, sociology, and all related disciplines.
The subclassification of homicide‐suicide into psychopathology and intrafamilial homicide‐suicides having been presented in the foregoing Parts I and II, this Part III concerns extrafamilial ...homicide‐suicides. Extrafamilial homicide‐suicides are divided into adversarial, autogenic mass, cult, and terrorist homicide‐suicides. Adversarial homicide‐suicides involve a “formal” relationship between actor and homicide victims, further divided according to the role of the actor in their relationship as employee, current or former pupil/student as in school shootings, patient, and litigant. For comparison, school shootings were divided into those resulting in 10 or more homicide victims and those with fewer. The autogenic mass homicide‐suicide, wherein victims are strangers to the actor, was heuristically bifurcated here depending on the number of homicide victims, 10 or more or fewer. As expected, the homicide‐suicides with larger numbers of victims were more homogenous.
Suicide is a troubling, preventable phenomenon. Prior to attempts, individuals often seek help, prompting practitioners to perform risk assessments that ideally use evidence‐based risk management ...strategies. A literature review was performed using Harvard Countway Library of Medicine, Google Scholar, PubMed. Key words used were “Forensic Science,” “Suicide Risk Management,” “Pediatric Suicide Risk Factors,” “Adult Suicide Risk Factors,” “Geriatric Suicide Risk Factors,” “Suicide Risk Assessment.” Parameters limited articles to studies/reviews completed in the past twenty years in the United States. Results indicated predictors of suicide in juveniles were insomnia, burdensomeness, and recent conflicts with family or a romantic partner. Adults had greater risk if male, substance abusing, with marital/job loss. Elderly individuals with multiple medical comorbidities, hopelessness, and isolation were at higher risk. Everyone evaluated should be screened for access to firearms. Management of suicide risk involves providing the least restrictive form of treatment which maintains an individual's safety.
A history of self-injurious thoughts and behaviors (SITBs) is consistently cited as one of the strongest predictors of future suicidal behavior. However, stark discrepancies in the literature raise ...questions about the true magnitude of these associations. The objective of this study is to examine the magnitude and clinical utility of the associations between SITBs and subsequent suicide ideation, attempts, and death.
We searched PubMed, PsycInfo, and Google Scholar for papers published through December 2014. Inclusion required that studies include at least one longitudinal analysis predicting suicide ideation, attempts, or death using any SITB variable. We identified 2179 longitudinal studies; 172 met inclusion criteria.
The most common outcome was suicide attempt (47.80%), followed by death (40.50%) and ideation (11.60%). Median follow-up was 52 months (mean = 82.52, s.d. = 102.29). Overall prediction was weak, with weighted mean odds ratios (ORs) of 2.07 95% confidence interval (CI) 1.76-2.43 for ideation, 2.14 (95% CI 2.00-2.30) for attempts, and 1.54 (95% CI 1.39-1.71) for death. Adjusting for publication bias further reduced estimates. Diagnostic accuracy analyses indicated acceptable specificity (86-87%) and poor sensitivity (10-26%), with areas under the curve marginally above chance (0.60-0.62). Most risk factors generated OR estimates of <2.0 and no risk factor exceeded 4.5. Effects were consistent regardless of sample severity, sample age groups, or follow-up length.
Prior SITBs confer risk for later suicidal thoughts and behaviors. However, they only provide a marginal improvement in diagnostic accuracy above chance. Addressing gaps in study design, assessment, and underlying mechanisms may prove useful in improving prediction and prevention of suicidal thoughts and behaviors.
Suicidal thoughts and behaviors (STBs) are major public health problems that have not declined appreciably in several decades. One of the first steps to improving the prevention and treatment of STBs ...is to establish risk factors (i.e., longitudinal predictors). To provide a summary of current knowledge about risk factors, we conducted a meta-analysis of studies that have attempted to longitudinally predict a specific STB-related outcome. This included 365 studies (3,428 total risk factor effect sizes) from the past 50 years. The present random-effects meta-analysis produced several unexpected findings: across odds ratio, hazard ratio, and diagnostic accuracy analyses, prediction was only slightly better than chance for all outcomes; no broad category or subcategory accurately predicted far above chance levels; predictive ability has not improved across 50 years of research; studies rarely examined the combined effect of multiple risk factors; risk factors have been homogenous over time, with 5 broad categories accounting for nearly 80% of all risk factor tests; and the average study was nearly 10 years long, but longer studies did not produce better prediction. The homogeneity of existing research means that the present meta-analysis could only speak to STB risk factor associations within very narrow methodological limits-limits that have not allowed for tests that approximate most STB theories. The present meta-analysis accordingly highlights several fundamental changes needed in future studies. In particular, these findings suggest the need for a shift in focus from risk factors to machine learning-based risk algorithms.
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