Suicide Risk Assessments: A Scientific and Ethical Critique

Journal of Bioethical Inquiry 19 (3):481-493 (2022)
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Abstract

There are widely held premises that suicide is almost exclusively the result of mental illness and there is “strong evidence for successfully detecting and managing suicidality in healthcare”. In this context, ‘zero-suicide’ policies have emerged, and suicide risk assessment tools have become a normative component of psychiatric practice. This essay discusses how suicide evolved from a moral to a medical problem and how, in an effort to reduce suicide, a paternalistic healthcare response emerged to predict those at high risk. The evidence for the premises is critiqued and shown to be problematic; and it is found that strong paternalistic interventions are being used more often than acknowledged. Using a Principles approach, the ethics of overriding autonomy in suicide prevention is considered. Ethical concerns are identified with the current approach which are potentially amplified by the use of these risk assessments. Furthermore, it is identified that the widespread use of risk assessments in health settings is equivalent to screening without regard to the ethical principles of screening. The essay concludes that this is unethical; that we should abandon the use of standardized suicide risk assessments and ‘zero-suicide’ policy; and that this may improve outcomes.

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Despair of the Intellect, but Hope of the Heart?Michael A. Ashby - 2022 - Journal of Bioethical Inquiry 19 (3):353-356.

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References found in this work

Two treatises of government.John Locke - 1947 - New York: Cambridge University Press. Edited by Peter Laslett.
Groundwork of the metaphysics of morals.Immanuel Kant - 1785 - In Elizabeth Schmidt Radcliffe, Richard McCarty, Fritz Allhoff & Anand Vaidya (eds.), Late Modern Philosophy: Essential Readings with Commentary. Blackwell.

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