Depression Suicide Is There Such a Thing as Rational Suicide? By Theodora Blanchfield, AMFT Theodora Blanchfield, AMFT Twitter Theodora Blanchfield is an Associate Marriage and Family Therapist and mental health writer. Learn about our editorial process Updated on November 17, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Daniel B. Block, MD Medically reviewed by Daniel B. Block, MD LinkedIn Twitter Daniel B. Block, MD, is an award-winning, board-certified psychiatrist who operates a private practice in Pennsylvania. Learn about our Medical Review Board Print Valentinrussanov / Getty Images Table of Contents View All Table of Contents Risk Factors Mental Health Conditions Psychotherapy and Rational Suicide Physician-Assisted Death A Word From Verywell Crisis Support If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. 988 Can suicide ever be rational? That's not an easy question to answer, and there's a lot of gray area, but ultimately the decision is between an individual, their doctor and the laws of their state. Physician-assisted death for those with a terminal illness is fairly widely supported. A 2018 Gallup poll found that more than 70 percent of those surveyed were in favor of a physician ending a terminally ill person’s life through lethal means. Among those who are terminally ill,more than three-quarters of people deal with depression, and nearly half (45 percent) experience suicidal ideation, for reasons including pain, fear of future pain, loss of control and a feeling that life is over. Why Do People Commit Suicide? Risk Factors Largely, the conversations around rational suicide and physician assisted death center around elderly, as suicide risk is higher in this population, but there are several other risk factors, including chronic illness and cancer. Advanced Age Age is one of the top risk factors for suicide. Although most suicide prevention programs focus on younger people, the risk for both elderly people taking suicidal actions and completing suicide are higher than in other groups. By the Numbers 25% of elderly people who attempt suicide will die, compared to just 0.5% in those under 65In the state of California in 2021, 87% of those who died by physician-assisted death were over the age of 60The suicide rate of men aged 65 to 74 nearly doubles the general public's rate. The suicide rate of men above the age of 74 triples that of the general public. 55% of late-life suicides are associated with physical illness Chronic Pain Chronic pain may be one of the risk factors for suicide since many dealing with chronic pain feel helpless or hopeless and want to escape the pain. This group may also engage in more pain-related catastrophizing or avoidance. People with chronic pain are between two and three times as likely to die by suicide or report suicide related-behaviors. Risk Factors Some of the risk factors for those with chronic pain include: the location or type of pain, experiencing a lower quality of life, a higher pain intensity, longer pain duration, or sleep-onset insomnia (the inability to stay asleep.) Migraines, psychogenic pain, and back pain were associated with increased likelihood of suicide completion. Because of these risk factors, the World Health Organization recommends clinical assessment of suicidal behaviors in anyone with chronic pain over the age of 10. Cancer Having cancer puts one at high risk for suicide,especially in particularly aggressive cancers like stomach or pancreatic cancer. The suicide rate for this population is nearly double that of the general public. Some reasons include the high costs of healthcare in the United States, people not wanting to be a burden on their families, and easier access to firearms. Mental Health Conditions For patients with physical health concerns that are hastening their death, support is generally fairly high for rational suicide. However, mental health concerns are different. Mental illness may sometimes be conflated with irrationality or incompetency, but some may argue that it is also possible to make a rational, thought-out decision to end one’s life. Those who believe that suicide cannot be rational for those with mental health issues argue that suicidality may be a part of the condition. On the other hand, those who believe in rational suicide for mental illness argue that suicide in physical health conditions may also be influenced by the disease. There is a bit more support for people with serious mental health conditions such as schizophrenia, where it is recognized that there is a much lower quality of life, including difficult side effects from medication, intense psychological suffering, physical functioning and a lack of economic stability. Psychotherapy and Rational Suicide Therapists were most accepting of people who chose to end their lives because of a terminal illness. Eighty-eight percent of those surveyed believed that suicide was rational if the following conditions were met: The person considering suicide has an "unremitting hopeless condition," including terminal illnesses, severe physical or psychological pain, and physically or mentally debilitating/deteriorating conditions.The decision is made by the individual—they are not coerced by others.The person has engaged in a thorough decision-making process, including consulting with a mental health and medical professional, considering the impact on significant others, consideration of alternatives, and consideration of whether suicide is aligned with one's values. There are various governing bodies and associations that oversee each type of mental health professional (e.g., the American Counseling Association for Licensed Mental Health Counselors and; the National Association of Social Workers for LCSWs). Each of these boards has slightly different codes of ethics, but most of them allow therapists to work with clients who are considering suicide as they are near death anyway. In typical psychotherapy situations, a therapist would be obligated to take reasonable measures to prevent the suicide. States with physician-assisted death laws or therapists protected by ethical codes allow them to address the end-of-life concerns and their autonomy instead. In these situations, therapists may explore grief, spiritual issues and self-determination. What Is a Suicide Pact? Existential Perspective & Therapy From a holistic existential therapy standpoint, the idea of existential coherence (how someone’s true self is or isn’t able to be present in the world) is explored. The deepest layer of this coherence deals with whether one wants to live or die, and it is believed suicidal crises occur from people questioning whether they want to take responsibility for their lives or not. Physician-Assisted Death If one is dealing with a terminal illness, certain states do allow for physician-assisted death, although they have different regulations. Below are the states that allow for physician-assisted death, which is defined as a physician giving a person the means/medication to die rather than the physician administering it. CaliforniaColoradoDistrict of ColumbiaHawaiiMaineMontanaNew JerseyOregonVermontWashington What the Process Looks Like Each state, however, has its own set of qualifications and regulations about how the process works. Generally, the process includes some form of the following criteria:The patient is expected to die (usually of a terminal illness) within a certain period of time (generally six months)The patient must make a combination of written and oral requests and undergo waiting periods (typically about 15 days between oral requests)The patient must be older than 18 years of age The patient must be able to make the decision on their own—mental screening may applyThe patient must be able to self-administer the drugThe patient’s physician must agree/approve A Word From Verywell We recognize the validity of deep suffering, both mentally and physically, and urge anyone in pain to talk to a medical and/or mental health professional. You do not have to go through any pain alone, and people are here to care for you and support your needs. 13 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. 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The Duty to Protect: Ethical, Legal, and Professional Considerations for Mental Health Professionals. American Psychological Association; 2009:195-208. DOI: 10.1037/11866-013 Frileux S, Lelièvre C, Sastre MTM, Mullet E, Sorum PC. When is physician assisted suicide or euthanasia acceptable? Journal of Medical Ethics. 2003;29(6):330-336. DOI: 10.1136/jme.29.6.330 By Theodora Blanchfield, AMFT Theodora Blanchfield is an Associate Marriage and Family Therapist and mental health writer. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist for Depression Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.