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Ryerson University
PHL 302
Glen Hoffmann

PHILOSOPHICAL AND ETHICAL ISSUES Rational suicide: uncertain moral ground Karen L. Rich PhD (c) RN Doctoral Candidate, School of Nursing, The University of Southern Mississippi, Hattiesburg, Mississippi, USA Janie B. Butts DSN RN Associate Professor, School of Nursing, The University of Southern Mississippi, Hattiesburg, Mississippi, USA Submitted for publication 25 April 2003 Accepted for publication 22 October 2003 Correspondence: RICHH K..L & BBUTTTSS JB.. 2004 )) Journal of Advanced Nursing 46(3), 270283 Karen Rich, Rational suicide: uncertain moral ground School of Nursing, Background. The ambiguities involving end-of-life issues, such as physician-assisted The University of Southern Mississippi, suicide and voluntary stopping of eating and drinking, have caused a blurring of the Hattiesburg, 2701 Hardy Street, denition of rational suicide and have prompted rich dialogue with moral deliber- ations that seem to be on disparate paths among bioethicists and other health care MS 39406, USA. professionals. With the evolution of advanced medical technology extending life E-mail: [email protected] expectancy in older, disabled, and terminally ill people, rational suicide has become a critical issue of debate. Aim. The purpose of this article is to address the ethical positions supporting and opposing rational suicide and to consider whether coherence can be achieved through an ethic of care. Findings. Attitudes towards suicide have been controversial, varying from accept- ance to non-acceptance depending on social, political and religious inuences. Nursing attitudes are no different from general societal attitudes and, consequently, nurses are treading on uncertain moral ground. Conclusion. Nurses who have not reected on the moral issues involved with rational suicide may be unprepared psychologically and professionally when working with patients who may be contemplating such actions. Keywords: rational suicide, physician-assisted suicide, end of life, nursing care, autonomy, ethic of care As if every passion didnt contain its quantum of reason! the hot debates and moral deliberations of bioethicists and (Nietzsche 1968) other health care professionals about rational suicide. With the continual progression of technological advancements in medicine, however, many people are asking the question, Introduction What is a good death? Thoughts about trying to experience A vast public health crisis that makes us so uncomfortable a good death have gained relevance in the last decade. The that we divert our eyes from it was a statement made by act, or one may say the consolation, of suicide is one way that Solomon (2001, p. 248) about suicide, and it has become a some believe that they might ensure a good death. A person stark reminder to society about the woes of suicide. In the who is debilitated or terminally ill may sometimes view United States, approximately 30 000 suicides are certied suicide as an escape from life or from an otherwise slow, each year, with one million people dying of suicide each year lingering wait for death with pain and suffering. worldwide (Johnstone 1999, Beauchamp & Childress 2001). Analysis of what is meant by rational suicide and its Questions of moral conict, such as deep, long-held values implications is not as explicit as one might anticipate. For and ideals about life and relationships, have surfaced from example, questions must be considered about what qualies 270 2004 Blackwell Publishing Ltd
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