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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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.
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


And for Canadian patients would we not provide them information on MAID?
And for any US States where it is legally available?
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


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.
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.
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!
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

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