Dear Barbara, I work for a hospice. We have had a couple of patients die by suicide. Do you have any suggestions on care for our staff as they are having difficulty processing these deaths?
Most people who can’t be fixed think about suicide in the months before death. Interestingly, very few actually do it. It takes a great deal of courage to end your life. BUT when they do, we as healthcare workers, tend to think "what could we have done to prevent this?"
I'm going to go out on a limb here and give you something to think about: Most of our patients (actually most people) are more afraid of dying than of being dead. That is why our patients think of ending their life early.
If I think my patient is having thoughts of suicide, we will talk about it. Is there a plan? Are they just questioning life and dying or have they reached the point of serious processing and planning? No judgement is given. Listening, answering questions and increasing visits so they feel less alone and more supported are the tools we bring. No need for a psychological evaluation, but I would encourage more social worker visits. Our social workers are great listeners and problem solvers. There are often concerns for their family that create thoughts of let’s just die now.
I don’t think I need to say this but I will anyway, we do not help or assist, in any way: a person ending their life—-EVER. I also tell the person thinking about suicide to not ask anyone to help them. Not only would they be putting that person in harm's way legally but also carrying the knowledge that we helped kill someone is a heavy weight to live with.
If a patient ends their life, as healthcare workers we bless this patient, have a closure gathering for the staff, assess our actions and care, and see that this patient was very brave. Really, nothing bad happened. He/she just died earlier than we thought they would.
Now our work is with the family to help them live with their grief. If I sound harsh, I don't mean to. I just want you to remember our work always (well mostly) involves dying and death. Some patients die faster than others. All of our patients will die. We comfort them and their families.
It is not our place to judge how others choose to leave this world. We do our best, we instruct, we guide, and we comfort, all around an ending of life.
We needn't lament over how it came but how we can support those that remain.
Something More... about End of Life Patients Who Are Thinking about Suicide
Knowledge reduces fear. Education is key in end of life care. Consider the End of Life Guideline series and NEW RULES for End of Life Care DVD.
13 comments
Johanna
In response to Jay’s question about VSED and hospice, definitely contact local hospices to enlist one which supports this. They will be able to come in a few days after VSED starts when there is “failure to thrive,” but it’s important to establish the relationship in advance. There is a very informative website: www.vsedresources.com. My father did VSED at age 86 and we were fully supported by his assisted living facility and hospice.
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BK Books replied:
Johanna, thank you for the VSED information. Blessings to you in the work you are doing. Barbara
In response to Jay’s question about VSED and hospice, definitely contact local hospices to enlist one which supports this. They will be able to come in a few days after VSED starts when there is “failure to thrive,” but it’s important to establish the relationship in advance. There is a very informative website: www.vsedresources.com. My father did VSED at age 86 and we were fully supported by his assisted living facility and hospice.
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BK Books replied:
Johanna, thank you for the VSED information. Blessings to you in the work you are doing. Barbara
April
I commented earlier and I wanted to clarify something I wrote. I said “we should not assist”. I didn’t mean that I am against legally assisted suicide…I’m not against it. I was just speaking as a hospice worker in TN where it’s not legal to assist. Mitzi in WA that commented spoke volumes. Her decision is not “knee jerk”. It has been well thought out. I think it was wonderful that she talked to her family about it. It’s a complex subject and we should be careful to be kind to each other.
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BK Books replied:
Thank you April for clarifying your comment. Blessings to you for the work you are doing. Barbara
I commented earlier and I wanted to clarify something I wrote. I said “we should not assist”. I didn’t mean that I am against legally assisted suicide…I’m not against it. I was just speaking as a hospice worker in TN where it’s not legal to assist. Mitzi in WA that commented spoke volumes. Her decision is not “knee jerk”. It has been well thought out. I think it was wonderful that she talked to her family about it. It’s a complex subject and we should be careful to be kind to each other.
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BK Books replied:
Thank you April for clarifying your comment. Blessings to you for the work you are doing. Barbara
Mitzi McCowan
Thank you for talking about suicide…I’m 66 yrs old, a widow & have terminal cancer. Within the next year, I will die by Assisted Suicide…I will be in WA State where it is legal. EVERYONE knows my thoughts & plans. I’ve been thinking about & planning this for nearly a year now. It’s not sad or scary too me in the least. My family & close friends have been very supportive. My 86 yr old dad was surprised when I discussed my decisions with him, but he does understand. My pain is tremendous now. I do have peace in my life & heart…your books helped me so much when my husband was on Hospice with Lewy-Body. I reread them, before my mother went on Hospice with Alz as well. Hospice has really been a blessing to me.
Thank you so much for your honest look at death & dying…you ROCK!!!
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BK Books replied:
Mitz, think about hospice when you decide to utilize MAID. Some hospices will support you and your family during that time. I’m holding you in my thoughts. Blessings to you and your family. Barbara
Thank you for talking about suicide…I’m 66 yrs old, a widow & have terminal cancer. Within the next year, I will die by Assisted Suicide…I will be in WA State where it is legal. EVERYONE knows my thoughts & plans. I’ve been thinking about & planning this for nearly a year now. It’s not sad or scary too me in the least. My family & close friends have been very supportive. My 86 yr old dad was surprised when I discussed my decisions with him, but he does understand. My pain is tremendous now. I do have peace in my life & heart…your books helped me so much when my husband was on Hospice with Lewy-Body. I reread them, before my mother went on Hospice with Alz as well. Hospice has really been a blessing to me.
Thank you so much for your honest look at death & dying…you ROCK!!!
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BK Books replied:
Mitz, think about hospice when you decide to utilize MAID. Some hospices will support you and your family during that time. I’m holding you in my thoughts. Blessings to you and your family. Barbara
Lizz Wallace
This maybe simplistic but sometimes antidepressants are effective.
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BK Books replied:
Liz, you are right, sometimes antidepressants help. I think they need to be considered and offered in all situations. Thank you for addressing that possibility. Blessings! Barbara
This maybe simplistic but sometimes antidepressants are effective.
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BK Books replied:
Liz, you are right, sometimes antidepressants help. I think they need to be considered and offered in all situations. Thank you for addressing that possibility. Blessings! Barbara
Claudia
I take exception with the statement, “Really, nothing bad happened. He/she just died earlier than we thought they would.” Hospice philosophy can be wonderful at supporting families during a loved one’s end-of-life journey, but death by suicide can be extremely traumatic for the friends, families, and hospice workers, especially those that were unfortunate to discover the death.
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BK Books replied:
Claudia, of course a death by suicide is very tramaatic and has lasting implications for those left behind. For one we, survivors, tend to carry more guilt with our grief. The “What if, I should have” thoughts that we often carry with us forever. Thank you for sharing your thoughts. Blessings! Barbara
I take exception with the statement, “Really, nothing bad happened. He/she just died earlier than we thought they would.” Hospice philosophy can be wonderful at supporting families during a loved one’s end-of-life journey, but death by suicide can be extremely traumatic for the friends, families, and hospice workers, especially those that were unfortunate to discover the death.
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BK Books replied:
Claudia, of course a death by suicide is very tramaatic and has lasting implications for those left behind. For one we, survivors, tend to carry more guilt with our grief. The “What if, I should have” thoughts that we often carry with us forever. Thank you for sharing your thoughts. Blessings! Barbara
Jay
Can hospice help if someone has decided to end their life by not eating or drinking? I mean if they have a derctive saying this is what want? I believe there is a name for it. Obviously you cannot do it on your own.
Thanks
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BK Books replied:
Hi Jay, it is called Voluntarily Stop Eating and Drinking (VSED). I’m not sure about hospices and taking someone on who has verbalized the decision to stop eating. My guess it would be up to each individual hospice. There is no law that says a person has to eat. Actually, you can just stop eating anytime you want. I’m not advocating doing it—just saying. Blessings to you! Barbara
Can hospice help if someone has decided to end their life by not eating or drinking? I mean if they have a derctive saying this is what want? I believe there is a name for it. Obviously you cannot do it on your own.
Thanks
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BK Books replied:
Hi Jay, it is called Voluntarily Stop Eating and Drinking (VSED). I’m not sure about hospices and taking someone on who has verbalized the decision to stop eating. My guess it would be up to each individual hospice. There is no law that says a person has to eat. Actually, you can just stop eating anytime you want. I’m not advocating doing it—just saying. Blessings to you! Barbara
Alison
And for Canadian patients would we not provide them information on MAID?
And for any US States where it is legally available?
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BK Books replied:
Alison, I do not know about Canada’s position on MAID. The states in the US according to Google are: OR, WA, MT, VT, CO, DC, Hawaii, NJ, Maine and NM. Blessings! Barbara
And for Canadian patients would we not provide them information on MAID?
And for any US States where it is legally available?
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BK Books replied:
Alison, I do not know about Canada’s position on MAID. The states in the US according to Google are: OR, WA, MT, VT, CO, DC, Hawaii, NJ, Maine and NM. Blessings! Barbara
April
I am a hospice aide. I have not had this come up, but it probably will at some point. Both my father and my daughter-in-law committed suicide. I can tell you from my experience, people who commit suicide are in a different mind frame than a “normal person“. You should not expect them to think the way that you do. We cannot judge them. I agree 100% that we should not assist. Not only could things go wrong but legally that could cause an immense amount of turmoil. And you just don’t know what you would go through emotionally until you were in the situation. Listen and care. It’s probably the most important thing we do anyway.
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BK Books replied:
Thank you April for your kind and wise words. Blessings to you in the work you are doing. Barbara
I am a hospice aide. I have not had this come up, but it probably will at some point. Both my father and my daughter-in-law committed suicide. I can tell you from my experience, people who commit suicide are in a different mind frame than a “normal person“. You should not expect them to think the way that you do. We cannot judge them. I agree 100% that we should not assist. Not only could things go wrong but legally that could cause an immense amount of turmoil. And you just don’t know what you would go through emotionally until you were in the situation. Listen and care. It’s probably the most important thing we do anyway.
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BK Books replied:
Thank you April for your kind and wise words. Blessings to you in the work you are doing. Barbara
Bonnie Nichols
What about in states where assisted suicide or death with dignity is permitted? The role and preparations would be different. It is not illegal in several states to have a plan to die on a certain day and then follow through with assistance from the medical doctor.
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BK Books replied:
Hi Bonnie, the operative words here are “assistance from a medical doctor”. It is not our place as healthcare workers to assist in ending a life. We can be listeners, offer our understanding but we cannot “help” even in states where it is legal. Blessings! Barbara
What about in states where assisted suicide or death with dignity is permitted? The role and preparations would be different. It is not illegal in several states to have a plan to die on a certain day and then follow through with assistance from the medical doctor.
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BK Books replied:
Hi Bonnie, the operative words here are “assistance from a medical doctor”. It is not our place as healthcare workers to assist in ending a life. We can be listeners, offer our understanding but we cannot “help” even in states where it is legal. Blessings! Barbara
David Klein
I had a patient who was having great pain and difficulty moving around her home. We had been providing therapies for her to reduce her pain and she was doing really well and not needing much pain medication. We saw her on a Friday afternoon and he next appointment was the following week. Before she left our office she thanked the doctors who were working with her. On the following Monday she did not show-up for her therapy and one of the office girls called her home only to find out that she had gone out in the garage and hung herself! We all talked about what we could have done to prevent this until one of the therapists said, once someone has their mind made up no one is going to stop them from taking their own life!
A lesson learned only to have the same thing happen a few years later!
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BK Books replied:
Hi David, we in healthcare do what we can to care for our patients. Sometimes it is just too hard to stay alive. Blessings! Barbara
I had a patient who was having great pain and difficulty moving around her home. We had been providing therapies for her to reduce her pain and she was doing really well and not needing much pain medication. We saw her on a Friday afternoon and he next appointment was the following week. Before she left our office she thanked the doctors who were working with her. On the following Monday she did not show-up for her therapy and one of the office girls called her home only to find out that she had gone out in the garage and hung herself! We all talked about what we could have done to prevent this until one of the therapists said, once someone has their mind made up no one is going to stop them from taking their own life!
A lesson learned only to have the same thing happen a few years later!
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BK Books replied:
Hi David, we in healthcare do what we can to care for our patients. Sometimes it is just too hard to stay alive. Blessings! Barbara
Mike
As a caregiver for my wife how has been on hospice for over a year and having a daughter who has been talking about suicide and failed at the age of twelve ( she is now fourtey-two) has multiple other problems , still threat and talks about suicide and my wife has mentioned it a few times.
I tell them both as long as they are here , I am here to love and care for and do not judge when or how they leave this world.
Yes I have opinions and comments to make but will not tell them because it’s my opinion and have no say to their ultimate decision.
Thanks Barbra for all your wisdom and helping in these hard times
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BK Books replied:
Oh Mike, you and your family are certainly facing some big challenges. I hope you have developed a relationship with the hospice social worker. Use her/him for your sounding board, guidance and support. Blessings to you and your family. Barbara
As a caregiver for my wife how has been on hospice for over a year and having a daughter who has been talking about suicide and failed at the age of twelve ( she is now fourtey-two) has multiple other problems , still threat and talks about suicide and my wife has mentioned it a few times.
I tell them both as long as they are here , I am here to love and care for and do not judge when or how they leave this world.
Yes I have opinions and comments to make but will not tell them because it’s my opinion and have no say to their ultimate decision.
Thanks Barbra for all your wisdom and helping in these hard times
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BK Books replied:
Oh Mike, you and your family are certainly facing some big challenges. I hope you have developed a relationship with the hospice social worker. Use her/him for your sounding board, guidance and support. Blessings to you and your family. Barbara
Jacqueline Saretsky
Good response Barbara. I would add that Spiritual Care staff are also good listeners and problem solvers.
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BK Books replied:
Hi Jacqueline, You are so right spiritual care staff can definitely provide comfort and listening ears. Blessings! Barbara
Good response Barbara. I would add that Spiritual Care staff are also good listeners and problem solvers.
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BK Books replied:
Hi Jacqueline, You are so right spiritual care staff can definitely provide comfort and listening ears. Blessings! Barbara
Nikki Gouzopoulos
This is so well said, Barbara. The topic of suicide and choosing your time to die is so taboo in our death denying culture. My father chose a medially assisted death four years ago. It is legal in Canada and I now volunteer with and support those choosing MAiD (medical assistance in dying) and those processing their grief of their loved one who has chosen their time of death. What you have written is so important for people to hear and understand. This takes a tremendous amount of bravery. My father died my hero. He chose to die with his dignity intact and on his own terms. There are no adequate words to express my appreciation and thanks for you and your work. Warmest regards!
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BK Books replied:
Nikki, thank you for sharing your father’s experience with us. Blessings to you and your family. Barbara
This is so well said, Barbara. The topic of suicide and choosing your time to die is so taboo in our death denying culture. My father chose a medially assisted death four years ago. It is legal in Canada and I now volunteer with and support those choosing MAiD (medical assistance in dying) and those processing their grief of their loved one who has chosen their time of death. What you have written is so important for people to hear and understand. This takes a tremendous amount of bravery. My father died my hero. He chose to die with his dignity intact and on his own terms. There are no adequate words to express my appreciation and thanks for you and your work. Warmest regards!
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BK Books replied:
Nikki, thank you for sharing your father’s experience with us. Blessings to you and your family. Barbara