Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.
CPLB (IFH), HBSP (SPH), Philosophy (SAS), Henry Rutgers Professor of Bioethics, Rutgers University, USA.
Br J Psychiatry. 2023 Jun;222(6):230-233. doi: 10.1192/bjp.2023.3.
Governments and non-governmental organisations are increasingly adopting a 'zero-suicide' goal, but what such a goal precisely involves is unclear. Ostensibly it strongly prioritises the prevention and elimination of all suicide. We argue that, so understood, a societal goal of zero suicide risks contravening several ethical principles. In terms of beneficence and non-maleficence, a 'zero-suicide' goal risks being inefficient and may burden or harm many people. Autonomy-wise, a blanket ban on all suicide is excessive. As regards social justice, zero suicide risks focusing on the symptoms of social malaise instead of the structures causing it. With respect to transparency, a 'zero' goal that cannot be met makes these authorities look detached and risks frustration, distrust and, worse, stigmatisation of suicide and of mental health conditions. Instead, we propose a middle path for suicide prevention, founded on harm reduction, 'soft group paternalism' and efforts directed at increased quality of life for disadvantaged groups. Although soft group paternalism respects autonomy, this approach permits coercive interferences in certain circumstances. We hope that the justificatory framework tying together these largely familiar elements is novel and sensible.
政府和非政府组织越来越多地采用“零自杀”目标,但这个目标究竟涉及什么尚不清楚。表面上看,它非常重视预防和消除所有自杀。我们认为,从这个角度理解,零自杀的社会目标可能违反了几项伦理原则。从慈善和不伤害的角度来看,零自杀的目标可能效率低下,可能会给许多人带来负担或伤害。从自主权的角度来看,全面禁止自杀是过分的。至于社会正义,零自杀可能会关注社会不适的症状,而不是导致这些症状的结构。在透明度方面,无法实现的“零”目标会让这些机构看起来冷漠,有可能导致沮丧、不信任,更糟糕的是,对自杀和心理健康状况的污名化。相反,我们建议采取一种预防自杀的中间道路,以减少伤害、“软性群体家长主义”以及提高弱势群体生活质量为基础。尽管软性群体家长主义尊重自主权,但这种方法允许在某些情况下进行强制性干预。我们希望将这些在很大程度上熟悉的要素联系在一起的论证框架是新颖而合理的。