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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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
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.
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!
BK Books replied:
Nikki, thank you for sharing your father’s experience with us. Blessings to you and your family. Barbara

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