Ultimate Risk and Final Paternalism: The Medicalization of Suicidal Acts and Wishes of People with Mental Disorders

Current mental health care is more and more empowering consumers and encouraging them to take ‘positive risks’ in order to make experiences on what works for the person and what not. Recovery and similar concepts aim at de-medicalizing important aspects of the life of people with mental disorders. At the same time there is a renewed discussion on suicidal acts and wishes by consumers, especially in terms of assisted suicide. Suicide assistance for people with mental disorders is usually prohibited by law in nearly all western countries. The ethical argument against suicide assistance refers mainly to the supposed mental incapacity of people with mental disorders when it comes to death wishes. In mental health care, suicidal thoughts, wishes and acts are regarded as part of the most serious risks that the care system has to deal with. Common sense knowledge on suicides in general indicates that up to 90 percent of suicides are caused by mental disorders. This paper argues that the handling of the suicide issue related to people with mental disorders is to a large degree paternalistic by medicalizing the ultimate risk. The paper makes a case for a rational concept of dealing with death wishes which does not any longer separate people with mental disorders from those without.  By doing so, the paper will review the empirical evidence of the main assumptions, namely the causes of suicide and mental incapacity of consumers, and will also review the main arguments for and against assisted suicide for people with mental disorders.