Is There Such a Thing as Rational Suicide?

person who is depressed

Valentinrussanov / Getty Images

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.

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. 

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 65
  • In the state of California in 2021, 87% of those who died by physician-assisted death were over the age of 60
  • The 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.


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. 

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.

  • California
  • Colorado
  • District of Columbia
  • Hawaii
  • Maine
  • Montana
  • New Jersey
  • Oregon
  • Vermont
  • Washington

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 apply
  • The patient must be able to self-administer the drug
  • The 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. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Brenan M. Americans' strong support for euthanasia persists.

  2. Block SD. Assessing and managing depression in the terminally ill patient. Acp-asim end-of-life care consensus panel. American college of physicians - american society of internal medicine. Ann Intern Med. 2000;132(3):209-218. DOI: 10.7326/0003-4819-132-3-200002010-00007

  3. Suicide. National Institute of Mental Health.

  4. VSB Center for Health Statistics and Informatics.

  5. Gramaglia C, Calati R, Zeppegno P. Rational suicide in late life: a systematic review of the literature. Medicina (Kaunas). 2019;55(10):656. DOI: 10.3390/medicina55100656

  6. Smith MT, Perlis ML, Haythornthwaite JA. Suicidal ideation in outpatients with chronic musculoskeletal pain: an exploratory study of the role of sleep onset insomnia and pain intensity. Clin J Pain. 2004;20(2):111-118. DOI: 10.1097/00002508-200403000-00008

  7. Racine M. Chronic pain and suicide risk: A comprehensive review. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2018;87:269-280. DOI: 10.1016/j.pnpbp.2017.08.020

  8. Heinrich M, Hofmann L, Baurecht H, et al. Suicide risk and mortality among patients with cancer. Nat Med. 2022;28(4):852-859.  DOI: 10.1016/j.pnpbp.2017.08.020

  9. Hewitt J. Why are people with mental illness excluded from the rational suicide debate? Int J Law Psychiatry. 2013;36(5-6):358-365. DOI: 10.1016/j.ijlp.2013.06.006

  10. Werth, J. L., Jr. (1996). Rational suicide? Implications for mental health professionals. Taylor & Francis.

  11. Rogers JR, Gueulette CM, Abbey-Hines J, Carney JV, Werth JL. Rational suicide: an empirical investigation of counselor attitudes. Journal of Counseling & Development. 2001;79(3):365-372. DOI: 10.1002/j.1556-6676.2001.tb01982.x

  12. Werth JL, Richmond JM. End-of-life decisions and the duty to protect. In: Werth JL, Welfel ER, Benjamin GAH, eds. The Duty to Protect: Ethical, Legal, and Professional Considerations for Mental Health Professionals. American Psychological Association; 2009:195-208. DOI: 10.1037/11866-013

  13. 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.