suicide

The act of intentionally killing oneself; also someone who does this. The frequency of attempted suicide is 20 times higher than actual suicide. Three times more women than men attempt suicide, and three times more men succeed. Men tend to use more violent methods like gunshot wounds to the head; women are more likely to take an overdose. Over 6,000 people in the USA use handguns to kill themselves each year. The highest suicide rate for both sexes is in the over-75 age group. Hungary has the highest suicide rate in this age category at 108 per 100,000 (1992). Suicide among people aged 18-24, although relatively infrequent, is the third leading cause of death, after accidents and homicides, in the UK.

Although considered a crime in most countries, some have considered it acceptable in the past, for example hara-kiri in Japan is a means of avoiding dishonour, and in India widows were thought to become deified by burning themselves on their husband's funeral pyre, a practice known as suttee.

Suicide rates vary considerably among countries. Rates below 5 per 100,000 are considered low; 5-15 medium; 15-30 high; and above 30 very high. Estonia has the highest suicide rate (38, 1993), and Armenia the lowest (2.8, 1992). Rates are lower in Latin America than in North America, and lower in southern Europe than in other European countries. Suicide rates in Islamic countries are considerably lower than in Buddhist or Christian countries, and Roman Catholic countries tend to have lower rates than Protestant ones. Suicide rates in the European states of the former USSR are very high. There has been an increase in suicide among elderly men and adolescents since 1960. In the USA, for example, suicide rates for the elderly increased 226% for men and 110%for women 1960-92. The UK is the only European country with a clear decrease in old-age suicide among both men and women (60% and 55% respectively, 1992), although in 1985-95 the overall suicide rate in the UK increased by 71%.

China accounts for 40% of the world's suicides and it is the only country where female suicides outnumber male suicides - approximately 25% of female deaths in the 15-44 age group are suicides.

In the USA it is commonly believed that those who attempt to take their own lives cannot have arrived at that decision reasonably and must be mentally ill. Consequently, those who attempt it and fail are remanded in custody and confined to a mental health facility until two staff doctors determine that they are no longer a threat to themselves. It is often considered a crime in law, with consequences for a suicide's estate, or criminal prosecution for unsuccessful attempt. Aiding and abetting another's suicide is often considered illegal. Survivors of joint suicides may be charged with manslaughter.

Suicide was declared a serious health threat in July 1999 by the US surgeon general David Satcher. His ‘plan of action’ includes 15 steps mainly directed towards educating the public and medical personnel on how to recognize a person who might attempt suicide. About 30,000 people killed themselves in 1997 in the USA, making suicide the eighth leading cause of death that year.

The US Attorney General John Ashcroft announced in November 2001 that Oregon physicians would lose their federal drug licences if they prescribed lethal doses of drugs to terminally ill patients. They had done so since Oregon's Death With Dignity Act became law in 1997, and 70 people have ended their lives there since then. Ashcroft's ruling reverses that of his predecessor, Janet Reno.

History Suicide has been recorded in history since the early Middle Ages with criminal and social penalties to anyone who attempted it. Until the Reformation, suicides were condemned by the church and the state. Until 1823, suicides were denied burial on consecrated ground; instead they were buried at night, without a service, at a crossroads and with a stake through the heart. Their possessions were also confiscated by the state.

Motivating and risk factors Suicide is related to mental illness (60-80% of suicides are in a state of depression), physical illness, alcohol and drug abuse, financial problems, and personal disputes. People are also more likely to commit suicide following a separation, divorce, or prior suicide attempt; if they are unemployed; if the means to commit it are readily available; and if there is a family history of suicide, mental disturbance, substance abuse, or violence, including emotional, physical, or sexual abuse. Hopelessness, the feeling that one does not have control over one's behaviour, feelings, or circumstances, is the greatest motivating factor contributing to suicide.

Counselling services Many countries have 24-hour telephone crisis lines offering confidential emotional support for people thinking of committing suicide. In the USA the service is called Help Line, in the UK the Samaritans, and in Australia Lifeline. Suicide is often extremely traumatic for friends and family members who, in addition to grief, may feel guilt, anger, and confusion over unresolved issues. Such people can benefit from survivor support groups.

Assisted suicide An increasing number of doctors believe that when a patient suffers from unbearable disabilities or terminal illness, they should be assisted to die, if they wish to, by removing life-prolonging treatment. Civil-rights groups advocate the use of living wills that give power of attorney if the patient is incapable of making such. Those opposed to assisted suicide claim that the vast majority of suicidal patients are depressed and therefore not in a competent frame of mind to make such a decision. They also fear that voluntary euthanasia will lead to involuntary euthanasia, where another person makes the decision. The issue has split the medical profession; some see it as incompatible with the physician's role as a healer, while others have drawn up guidelines on its practice. The leading spokesperson and practitioner of euthanasia in the USA is Jack Kevorkian; by September 1996 he had helped 40 patients to die.

Euthanasia was legalized in the Netherlands in 1973. In 1990, 11,800 patients (9% of all deaths) in the Netherlands were as a result of euthanasia. It has to be carried out under strict guidelines, with the request made voluntarily and in writing, attended by two witnesses with no financial relationship to the patient. Patients must receive a second opinion on their condition and are also referred to a psychiatrist for consultation. In July 1996 Australia's Northern Territory passed the Rights of the Terminally Ill Act allowing physicians to assist the terminally ill to die.

Mass suicides Mass suicides occasionally occur within religious cults. In Jonestown, Guyana, 911 members of the People's Temple, followers of the reverend Jimmy Jones, committed suicide in 1978 by drinking Kool Aid laced with cyanide. In 1993, 86 members of David Koresh's Branch Davidians killed themselves by setting fire to their compound in Waco, Texas; and in 1994, 53 members of the Order of the Solar Temple simultaneously committed suicide in several chalets in Switzerland and Canada, followed by 16 more December 1995.