The Darkness at the End of Life: Suicide in Palliative Care Settings

Abstract

In palliative care, a death by suicide can be a tragic event. The evaluation and management of patients in these settings can be complex as suicidal ideation or intent can differ from a desire for hastened death, a request for medical aid in dying, euthanasia, or comfort care measures. There is still no clear consensus as how to manage clinical situations in this sensitive topic. In the evaluation of suicide risk in patients with a terminal disease, it is crucial to assess for pain and other physical symptoms, delirium and cognitive disorders, depression, anxiety, fear of losing control or becoming a burden to others, the patient’s current social support, history of psychiatric disorders and treatments, and spiritual and existential aspects. Often it can be helpful to address physical symptoms. The alleviation of a patient’s pain can affect the degree of a person’s suicidal ideation even to remission. It is important to evaluate psychological defenses and severity of psychiatric symptoms as well as possible existential concerns. In the management of this population, psychotherapy and somatic therapies must be considered. Dignity therapy and meaning-centered psychotherapy are two recent forms of psychotherapy that specifically address the particular circumstances of these patients. Compassionate care is essential. In palliative care settings, patients deal not only with pain and physical and depressive symptoms but with the existential anxiety of dying and, as such, facing the uncertainty of the unknown.