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Shuffling off this mortal coil.

Did you know that terminally ill cancer patients are rarely suicidal? Neither did 75 percent of primary care physicians responding to a questionnaire testing their knowledge and attitudes about suicide, reports the American Medical News (20 April 1992). The survey, conducted by Yeates Conwell, a psychiatrist at the University of Rochester, also found that over half of the 114 respondents either were uncertain or believed, mistakenly, that suicide often occurs in the absence of psychiatric illness, and less than half knew that the elderly have the highest suicide rate.

Is such doctorly ignorance dangerous? Arguably it is, as about 75 percent of patients who try to kill themselves visit their physicians within a month of the attempt. Practitioners who know all the suicide risk factors are better prepared to intervene. Indeed, those who scored highest on the Rochester questionnaire were most likely to refer patients to mental health professionals and to prescribe antidepressants.

Perhaps, along with such risk factors as substance abuse, social isolation, and physical illness, reading Final Exit should count as a serious indicator of suicidal ideation. A letter in the 26 March 1992 issue of NEJM reports a case in which a "depressed but otherwise healthy" woman tried to obtain cyanide from a pharmacy after reading the book by Derek Humphrey that has achieved notoriety as a suicide manual. Unsuccessful in her attempt to buy the poison, she then slashed her throat and wrist. After being treated and returning home, her physicians report, "she was feeling much better" and was no longer suicidal.

And a UPI story of 23 April 1992 reported that two brothers in their mid-thirties, both ill and despondent, apparently used a method of suicide described in Final Exit A copy of the book was found on a nearby nightstand, marked at the relevant page, while the ingredients for the method were also found nearby.

Even if Final Exit were added to the list of risk factors for suicide, certain interventions would doubtless be less welcome than others. According to the April 1992 issue of Hemlock Quarterly, a Florida woman, worried about side-effects of the Prednisone she was taking, mentioned to her physician certain medications that she felt might overcome its bad effects. When he asked where she had learned of these medications she told him she had been reading Humphrey's book. Later in the day a sheriff and his deputy turned up on her doorstep, having been told by her physician that she was suicidal. Although she was shown no commitment papers, she was taken to a mental hospital, where she was denied visitors or phone calls, kept for two days, and then released. The hospital billed her for $1,600.
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Author:Nelson, Hilde L.
Publication:The Hastings Center Report
Date:Jul 1, 1992
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