Assisted Suicide Can Incite Feelings of Moral Conflict, Isolation, Secrecy in Grieving Relatives

By Rob Goodier

NEW YORK- Three trends stand out in the grieving process before and after a loved one commits suicide with a physician's assistance, a new study of families in Switzerland suggests.

The survivors may feel morally conflicted about the decision, prefer to maintain secrecy about the suicide and, often as a consequence, they feel isolated from their friends and families.

Healthcare professionals should be aware of these issues, and the management of assisted suicide should include provisions for family members, the researchers say.

"A proper recognition and assessment of the relatives' experience is needed in order to provide support during the process," Dr. Claudia Gamondi of the Oncology Institute of Southern Switzerland in Ticino and colleagues wrote in a paper released online September 3 in BMJ: Supportive and Palliative Care.

Also, they wrote, "Acknowledgment of the experiences of family members should be an essential component of all research investigating assisted suicide."

Switzerland is one of a handful of countries and states in which physician-assisted suicide is not prosecuted. In the United States, it is legal in the states of Montana, Oregon, Washington and Vermont.

To learn more about the grieving process, the researchers interviewed 11 family members of eight patients whose doctors helped them commit suicide. They approached 15 for inclusion in the study but four declined to talk about it because it would have been too difficult.

All of the participants expressed feeling morally conflicted as their relatives made the decision to end their lives. Their dilemmas turned on questions such as whether it was the right thing to do, whether it was the right time, and whether or how they should be involved in the decision. In some cases, their conflict persisted for months after the relative's death.

Six of the participants took an active role in the decision by proposing suicide or otherwise becoming involved in the process. Those active participants tended to resolve their moral conflicts earlier and did not feel as troubled as the five who took a passive role.

Stemming in part from the moral ambiguity they experienced, the participants felt a need for secrecy.

"In our study, all family members, independently from their views seemed generally unprepared to disclose either the type of death or their involvement in it," the researchers write.

And the participants felt isolated from their friends and communities, in part because they felt that they had to maintain their secret.

"My mum doesn't speak of our uncle's assisted suicide, because she believes these are things that you shouldn't do, that it is a mortal sin," the anonymous 43-year-old nephew of a terminally ill patient who committed suicide with a doctor's assistance told researchers in one example.

The findings imply a need for guidelines on the care of the relatives of assisted suicides and also for future research into the impact of such guidelines, the researchers write.

Dr. Gamondi did not reply quickly to a request for comment.

SOURCE: https://bit.ly/1ag2spp

BMJ Support Palliat Care 2013.