Suicide risk assessments: a scientific and ethical critique

Mike Smith

Suicide rates have been increasing and there is a global imperative to address this. In healthcare a policy has emerged which involves the widespread use of suicide risk assessments in mental health interactions as a way to detect and predict risk of suicide. This policy is predicated on a medical model of suicide which asserts that suicide is almost exclusively the result of mental illness. This essay considers the origins of this medical model and outlines the ethical justifications for suicide prevention in healthcare, specifically the role of paternalism, predicated on beneficience in individuals who have impaired autonomy as a result of mental illness. The medical model is then critiqued and shown to be flawed and it is determined that paternalistic interventions are likely being directed toward individuals whose autonomy remains intact. The evidence to justify overriding intact autonomy, using this policy, is reviewed, and shown to not only be insufficiently demonstrable of beneficience and non-maleficience, but suggestive of harm. This leads to a conclusion that the current widespread use of suicide risk assessments in clinical practice is ethically problematic.

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