Suicide and Attempted Suicide: Methods and Consequences - Hardcover

Stone, Geo

Hardcover

ISBN 10: 0786704926 ISBN 13: 9780786704927

Publisher: Da Capo Lifelong Books, 1999

Synopsis

A brave, compassionate, and ethical study examines the methods, unforeseen results, and other alternatives to suicide and discusses such topics as the psychological makeup of suicidal people, ways to prevent suicide, the comfort care and hospice care available for those who disable themselves, and more.

About this title

Reviews

This is essentially a guide on how to commit suicide, or alternatively, stage a ``safe'' suicidal gesture. Stone (who has studied pharmacology at George Washington University Medical School and the National Institutes of Health) offers little backgroundpersonal, occupational, educational, familial, religious, or otherwisewhich might help readers absorb this work into some kind of useful discussion. Stone does set out his basic premises: first, that it is each person's right to make decisions concerning his own death, and second, that most decisions to commit suicide are due to temporary problems and are therefore tragic mistakes.'' Stone goes on, in a pragmatic, almost cold-blooded, tone to set out an immense amount of information on suicide and attempted suicide. He delineates four groups of people who attempt to kill themselves: rational people facing an insoluble problem, usually fatal illness; those acting on impulse, temporarily miserableand often drunk; those who are irrational due to depression, schizophrenia, or alcoholism; and those who are making a desperate bid for attention or help. Stone also looks at issues around terminal illness and euthanasia. In Part II, he explains the following methods of killing oneself: asphyxia, cutting and stabbing, drowning, drugs, chemicals, poisons, electrocution, gunshot, strangulation, hypothermia, and jumping. He includes explicit instructions on how to go about each method, and what the likely physiological damage will be if the attempt fails. Difficult as all this is to take in, there is moreinformation on how to make a relatively safe suicidal gesture will certainly confound readers, as will descriptions of autopsy results and asides on the strange and various ways people hurt themselves. The technical information here is accurate. But to approach such a stunningly painful, morally loaded, politically hot subject constructively, we need more than information. We need to know who our guide is, how he has come to this place, how and why his view was formed. -- Copyright ©1999, Kirkus Associates, LP. All rights reserved.

Excerpt. © Reprinted by permission. All rights reserved.

From Part I: Background ...Ironically, this well-intentioned and humanitarian opposition to suicide eventually degenerated into "...legalized and sanctified atrocities, by which the body of the suicide was degraded, his memory defamed, his family persecuted." Suicides were buried at crossroads with a stake through their bodies, and their property confiscated by the State. Perhaps the ultimate irony was the execution of people for the crime of attempting to commit suicide...

...More recently, with the advent of "anti-psychosis" drugs, such as Thorazine, in the 1950s, the concept of a biochemical basis for behavior has become increasingly persuasive.

One of the effects of these changes has been to largely remove suicide from the category of "moral crime." Instead, the fault has been shifted onto society, mental illness, or biochemical imbalance, things for which an individual can hardly be blamed.

Thus, if suicide is involuntary and beyond an individual's control, rational or moral arguments against it will be useless. The only moral question, then, will be that of intervention, abstention, or assistance by individuals or society-at-large...

...One of the ironies of suicide is that a suicide attempt--if survived--is probably the most dramatic and convincing way to draw attention to a problem and get help. Often family, psychiatric, and social service resources become suddenly available. A survey of Swiss survivors found that a majority felt that their actions had positive consequences for them. In Erwin Stengel's words, "The suicidal attempt is a highly effective though hazardous way of influencing others and its effects are as a rule...lasting."

...One of the ironic and presumably unintended results of making assisted suicide illegal is the pressure it puts on the old, infirm, and ill to kill themselves while they are still able to do so, and sooner than they would if they could count on help...

...This is a truly bizarre situation: EVERY study I've seen finds pain seriously undertreated; EVERY expert recommends more use of pain medications. Yet the problem persists.

Thus, Dr. Cundiff believes, with considerable justification, "We don't need a law to legalize assisted suicide, we need a law to teach doctors how to treat pain."

...There are two related practical problems with assisted suicide: (1) in most places it's illegal; (2) in many cases the job is bungled. As a result, end-of-life discussion between patient and doctor is often inhibited: physicians fear prosecution; patients fear involuntary commitment and deprivation of pain medication. The result is, all too often, badly-informed decisions badly carried out...

From Part II: Methods

Cutting/stabbing looks like one of the safer methods for a suicidal gesture because it has the lowest fatality rate, 4.1% - 5.8%...However, as mentioned earlier, all these data combine people intending to die with those wanting help or attention.

...Cuts on the wrist, and to a much lesser extent elbow or ankle, are often used to make a suicidal gesture. Such wrist cuts are generally shallow and perpendicular to the long bones of the forearm. They tend to sever the surface veins. Since these veins are neither particularly large nor carry as much pressure as the arteries, such cuts are not usually life-threatening because they can clot before a fatal quantity of blood is lost.

Wrist cuts become more dangerous:

(1) if the cuts are more-or-less parallel to the long bones. In such cases the blood vessels tend to be sliced lengthwise or diagonally, making clotting more difficult and thus allowing more and faster blood loss.

(2) if cuts are deeper and near the long bones of the forearm (the thumb-side long bone is the radius; the other long bone is the ulna), they may sever the radial artery or the ulnar artery. These pieces of plumbing ARE under high pressure, and cutting them can be fatal unless the bleeding is actively stanched.

There are claims that a single cut across a healthy wrist artery is not dangerous, because the cut artery (which, unlike veins, has built-in muscle) will contract and so limit blood loss. While this protective mechanism does exist, it's not always sufficient: four of the forty Stockholm deaths due to cuts on the limbs were from just such an injury;

You can find (or usually avoid) these arteries by checking various points around your wrist for a pulse. Without a stethoscope you will only detect one in a couple of spots, e.g., where your wrist and thumb come together. You can locate the radial artery fairly near the surface there. The other major wrist artery, the ulnar, runs parallel to the other forearm bone and can be felt near the heel of the hand.

Hyperextending the wrist is common, but hides the radial artery around the end of the radius (try feeling for the pulse), and one may end up with only severed flexor tendons.

...You may prefer to use an ankle vein in order to avoid wrist scars, and subsequent tedious cocktail-party conversation...

(3) if cuts are numerous. Multiple cuts of wrists, elbows, and ankles, none individually dangerous, may cause enough blood loss to be fatal.

(4) if clotting is inhibited. This may be deliberately done by keeping the cut under water. Another way to slow clotting is with drugs. Some drugs, like heparin and coumarin-like compounds [footnote], are prescribed specifically to decrease blood clotting in medical conditions like stroke. With other drugs, the anti-clotting ability is usually considered a "side effect" to its intended therapeutic use. Aspirin, when taken for pain relief, is the most common drug of this sort. Since many people are not aware of these effects, use of such drugs may occasionally turn a suicidal gesture into an accidental suicide...

...As methods of suicide, cutting and stabbing have little to recommend them: compared to lower-trauma asphyxias (see "Hanging" and "Asphyxia" chapters) they are, generally, more painful, and no faster or more reliable. Their major advantage is that (depending on site and method) you may, after the injury, have some time to change your mind.

Edition details

• Publisher: Da Capo Lifelong Books
• Publication date: 1999
• ISBN 10: 0786704926
• ISBN 13: 9780786704927
• Binding: Hardcover
• Language: English
• Number of pages: 480