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Ethical challenges faced by healthcare professionals who care for suicidal patients: a scoping review

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Abstract

For each one of the approximately 800,000 people who die from suicide every year, an additional twenty people attempt suicide. Many of these attempts result in hospitalization or in contact with other healthcare services. However, many personal, educational, and institutional barriers make it difficult for healthcare professionals to care for suicidal individuals. We reviewed literature that discusses suicidal patients in healthcare settings in order to highlight common ethical issues and to identify knowledge gaps. A sample was generated via PubMed using keywords “[(ethics OR *ethic*) AND suicid*] AND [English (Language) OR French (Language)]” (final N = 52), ethics content was extracted according to scoping review methodology, and categorized thematically. We identified three main areas posing ethical challenges for health professionals caring for suicidal individuals and their families. These were: (1) making clinical decisions for patients in acute care or when presented with specific circumstances; (2) issues arising from therapeutic relationships in chronic care, and (3) organizational factors. There is considerable uncertainty about how to resolve ethical issues when caring for someone who is suicidal. The stigma associated with suicide and mental illness, problems associated with risk–benefit assessments, and the fear of being held liable for malpractice should a patient die by suicide were overarching themes present across these three categories. Caring for suicidal patients is clinically and ethically challenging. The current literature highlights the complexity and range of decisions that need to be made. More attention should be paid to the difficulties faced by healthcare professionals and the development of solutions.

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Acknowledgements

Funding came from the Réseau québécois sur le suicide, les troubles de l’humeur et les troubles associés (RQSHA) and a Fonds de recherche du Quebec – santé (FRQS) Career Award (ER). Monique Séguin and Laurence Kirmayer provided input on this project, and Kaylee Sohng reviewed the charting during data extraction. We would also like to thank the members of the RQSHA who participated in the consultation phase (Catherine Gros, Gabriella Gobbi, Monique Séguin, and William Affleck). VS and ER are both members of the Psychosocial, Ethical and Aboriginal Health Research group within the RQSHA. Thanks to Sonja Chu for editorial assistance. The authors have no other conflicts to disclose.

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  1. Neuroethics Research Unit, Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, Montreal, QC, H2W lR7, Canada

    Victoria Saigle & Eric Racine

  2. Biomedical Ethics Unit, Department of Experimental Medicine, McGill University, Montreal, QC, Canada

    Victoria Saigle & Eric Racine

  3. Department of Medicine, Université de Montréal, Montreal, QC, Canada

    Eric Racine

  4. Department of Social and Preventative Medicine, Université de Montréal, Montreal, QC, Canada

    Eric Racine

  5. Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada

    Eric Racine

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Saigle, V., Racine, E. Ethical challenges faced by healthcare professionals who care for suicidal patients: a scoping review. Monash Bioeth. Rev. 35, 50–79 (2018). https://doi.org/10.1007/s40592-018-0076-z

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