End of Life Patients Who Are Thinking about Suicide

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.

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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.
BK Books replied:
Johanna, thank you for the VSED information. Blessings to you in 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.
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!!!
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.
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


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.
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

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