suicide,a rising trend

Suicide-A rising trend

Introduction:

Allah says in Holy Quran in (Nisa: 5:29, 5:30) about suicide that, “don’t kill yourself. No doubt Allah (swt) is merciful and anyone who does so will be pushed in fire. And it is easy for Allah (swt).

Without coming to this world and without dying can’t go to paradise. We can’t dream to go to final destination without tasting death. So we have to die whether we like it or not death is truth (Haqq)... It is passage to paradise therefore it is important that we remember the death and prepare for it.

Suicide (Latin suicidium, from Sui caedere, “to kill one self”) is the act of a human being intentionally causing his or her own death. Suicide is often committed out of despair, or attributed some underline mental disorder which includes depression, bipolar disorder, schizophrenia, and alcoholism and drug abuse. Pressures or misfortune such as financial difficulties or troubles with inter personal relationship may play significant role.

The world health organization estimates that it is the thirteen-leading cause of death worldwide. It is leading cause of death among teen ager and adult under 35. The rate of suicide is higher in man than in women. There are an estimated 10 to 20 million non fetal attempt suicide every year worldwide.

Due on suicide have been influenced by brooder cultural view on existential themes such as religion, owner and the meaning of life. The Abraham religion considers suicide an offense to world God due to religious believe in the sanctity of life. In the west it was often regarded as a serious crime.  In the 20^th century suicide in form of self-immolation has been used as form of protest and in the form of kamikaze and suicide bombing as a military or terrorist tactic Sati is Hindu funeral practice in which the widow would immolate herself on her husband’s funeral pyre, either willingly or under pressure from the family and in-laws.

Self sacrifice for others is not always considered suicide, as the goal is not to kill one self but to safe other; however, Emile Durkheim’s theory termed such acts “altruistic suicide”

QURAN AND SUNNAH:

The religion of Islam is based upon intentions, as we are judged according to our intentions. A good deed is not accepted by Allah if we intentions other than doing it for the sake of Allah, or if is not in accordance with Quran and Sunnah… Following are three verses in sequence:-

Ruling of Scholar of Today’s Times: on a suicide is that a person who has killed himself should be washed, prayed over and buried with the Muslims, because he is a sinner but he is not a Kaafir, Killing one-self is a sin but it is not Kufr. If he killed himself-we seek refuge with Allah – he should be washed, shrouded and prayed over, but the Khaleefah and important people should not pray for him, by way of rebuke, lest anyone think that they approve of what he did. If the Khaleefah, ruler, judges, president or mayor do not pray over him in order to denounce this action and announce that it is wrong, then this good, but some of the Muslims should still offer the (funeral) prayer for him.

Kitaab Majmoo’ Fataawa wa Maqaalaat Mutanawwi’ah li Sammahat al-Shaykh ‘Abd al-‘Azeez ibn ‘Abd-Allah ibn BAaz (may Allah have mercy on him) – vol. 13, p.112

HISTORY AND LEGISLATION:

            Historical laws against suicide and mercy killing have developed from religious doctrine, for example, the claim that only God has the right to determine when a person will die. The person who had committed suicide (without the approval of the state) was denied the honors of a normal burial. The person would be buried alone, on the outskirts of the city, without a headstone or marker. A criminal ordinance issued by Louis XIV in 1670 was far more severs in its punishment: the dead person’s body was drawn through the streets, face down and then hung or thrown on a garbage heap. Additionally, all of the person’s property was confiscated. By contrast, soldiers who had been defeated were expected to commit suicide in Ancient Rome and Japan. Even in modern times, legal penalties for committing suicide and homicide, through suicide still resulted in forfeiture of estate. Also, the deceased were permitted daylight burial in 1882.

            In many jurisdictions it is a crime to assist other, directly or indirectly, in taking their own live. In some jurisdictions, it is also illegal to encourage them to do so. Sometimes an exception applies for physician assisted suicide (PAS), under strict conditions. Let’s see laws of different countries concerned with suicide:-

Pakistani Law:

            Pakistan penal court PPC Act 325 defines that survivor of the suicide attempt may have one year simple imprisonment or fine or both. PPC has Act 107-10 for the assistance of suicide; it has the punishment of same as that of suicide i.e. 302/109 if suicide dies and 325/109 if he survives. So it means giving assistance or even provoking a person to commit suicide is as doing a homicide. If person has committed mass suicide or suicidal attack and survived then he will be additionally charged for homicidal charges as well the charges of attempted suicide.

United States Law:

            Historically, various states listed the act of suicide as a felony, but these policies were sparsely enforced. In the late 1980s, thirty of the fifty states had no laws against suicide or suicide attempts but every state had laws declaring it to be felony to aid, advice or encourage as a crime, and these have since removed that classification. In some U.S states, suicide is still considered an unwritten “common_law_crime.” As stated in Blackstone’s Commentaries. (So held the Virginia Supreme Court in Walckwitz V.Roy in 1992.) As a common law crime, suicide can bar recovery for the late suicidal person’s family in a lawsuit unless the suicidal person can be proven to have been “of unsound mind.” That is, the suicide must be proven to have been an involuntary to act of the victim in order for the family to be awarded monetary damages by the court. This can occur when the family of the deceased sues care giver (perhaps a jail or hospital) for negligence in failing to provide appropriate care. Some American legal scholar looks at the issue as one of personal liberty. According to Nadine Strossen, former president of ACLU, “the idea of Govt. making determination about how you and your life, forcing you…could be considered cruel and unusual punishment in certain circumstances and justice Stevens in a very interesting opinion in a right-to-die raised analogy.”

            Physician-Assisted suicide is legal in some state. For the terminally ill, it is legal in the state of Oregon under the Oregon Death with Dignity Act. In Washington State, it became legal in 2009, when a law modeled after the Oregon act, the Washington Death with Dignity Act was passed. A patient must be diagnosed as having less than six by two different doctors, then wait 15 days and make the request again. A doctor may prescribe a lethal dose but may not administer it. In many jurisdictions, medical facilities are empowered or required to commit any one whom they believe to be suicide for evaluation and treatment.

Australian Law:

            In the Australian state of Victoria, while suicide itself is no longer a crime, a survivor of a suicide pact can be charged with manslaughter, Also, it is a crime to counsel, incite, or aid and abet another in attempting to commit suicide, and the law explicitly allows any person to use “such force as may reasonably be necessary” to prevent another from committing suicide.

England & Wales Law:

            Laws against suicide (and attempted suicide) prevailed in English common law until 1961, English law perceived suicide as an immoral, criminal offense against God and also against the King. Suicide ceased to be a legal offense with the passing of the Suicide Act 1961; the same Act makes it an offense to assist in a suicide.

Indian Law:

            In India, attempted suicide is an offence punishable under section 309 of the Indian Penal Code. Section 309 reads thus: Attempt to commit suicide. “Whoever attempts to commit suicide and does any act towards the commission of such offence shall be punished with simple imprisonment for a term which may extend to one year or with fine, or with both.”

Ireland law:

            Attempted suicide is not a criminal offence in Ireland, and under Irish law self- harm is not generally seen as a form of attempted suicide. Assisted suicide and euthanasia are, however, illegal.

Netherlands law:

            In the Netherlands, being present and giving moral support during someone’s suicide is not a crime; neither is supplying general information on suicide techniques. However, it is a crime to participate in the preparation for or execution of a suicide, including supplying lethal means or instruction in their use. (Physician-assisted suicide may be an exception.)

Russian Federation Law:

            In Russia, inciting someone to suicide by threats, cruel treatment, or systematic humiliation is punishable by up to 5 year in prison. (Article 110 of the Criminal Code of the Russian Federation)

Scotland Law:

There was no legislation on this topic in England and Wales until 1961 when the Suicide Act was passed. Contemporarily, suicide is not and offence under Scots Law. However, the offense of attempting suicide is a Breach of the peace. A person who assists a suicide might be charged with murder, culpable homicide, or no offense depending upon the facts of each case.

Singapore Law:

In Singapore, a person who attempts to commit suicide can be imprisoned for up to one year.

Epidemiology:

Suicide is thirteenth leading cause of death worldwide with about a million people dying by suicide annually. According to 2007 data, suicide in US out number homicides by nearly 2 to 1 and ranks as 11 leading cause of death in the country, ahead of liver decease and Parkinson’s. World Wide suicide rate has increase by 60% in the past 50 year, mainly in developing country.

Gender & Age:

Man commits suicide far more frequently than women. In the western world, males died much more often by means of suicide then do female, although female attempt suicide more often. Some medical professional believe stems from the fact that males are more likely to end their lives through active violent means, while women primary useless severe methods such as overdosing on medication.

In general, the suicide rate increases with age, with a major significant spike in adolescents and young adults. In recent decades, a dramatically higher number of adolescent suicides have occurred. The 2007 Youth Risk Behavior Surveillance has shown that 6.9% of high school students had attempted suicide in the year prior to the survey. With increasing age, a critical relationship emerges between suicide and increasing age. Geriatric suicide is extremely prevalent. People older than 65 years have the highest rate of suicide. In 2004, the incidence of suicide in those aged 65 years and older was 14.3 for every 100,000 people. That age group also maintains an alarming connection with murder-suicides.

Ethnicity:

National suicide rates differ significantly between countries and amongst ethnic group within countries. For example in the US non Hispanic Caucasians are nearly 2.5 times more likely to kill themselves then African, American or Hispanic. In the United Kingdom suicide rates vary significantly between different parts of country. In Scotland, for example the suicide rate is approximately double that of England.

Social Aspects:

The predominant view of modern medicine is that suicide is a mental health concern, associated with psychological factor such as difficulties of copying with depression, inescapable suffering or fear, or other mental disorder and pressure. A suicide attempt is sometimes interrupted as a “cry for help”, or to express despair and the wish to escape, rather than a genuine intent to die. Most people who attempt suicide do not complete suicide on a first attempt; those who later gain a history of repetition have a significantly higher probability of eventual completion of suicide.

In the United state, individual who express the intent to harm themselves may be automatically to lack the present mental capacity to refuse treatment, and can be transported to the emergency department against their will.  And emergency physician will determine whether in patient care at a mental care facility is warranted. This is sometimes referred to as being “committed “. A court hearing may be held to determine the individual‘s competence. In most states, a psychiatrist may hold the person for specific time without a judicial order. If the psychiatrist decides that this particular person can be a threat to himself or others, the person may be admitted involuntarily to a psychiatric treatment facility. This period is usually for three days duration. After this time the person must be discharged or appear in front of a judge. As in any judicial proceeding this person has a right to legal counsel. Switzerland has recently taken steps to legalize assisted for the chronically ill. The high court in Lausanne, in a 2006 ruling, granted an anonymous individual with long standing psychiatric difficulties the right to end his known life. At least one leading American bioethicist, Jacob Appel to Brown University, has argued that the American medical community ought to condone suicide in certain individuals with mental illness.

CLASSIFICATION:

1.    Euthanasia and assisted suicide: Individual who wish to end their own lives may enlist the assistant of another person to achieve death. The other person, usually family member or a physician, may help carry out the act if the individual lacks the physical capacity to do so even with the supplied means. Assisted suicide is continuous moral and political issue in many countries, as seen in scandal surrounding Dr. Jack Kevorkian, a medical practitioner who supported euthanasia, was found to have helped patient and their own life and was sentence to prison time.

2.    Murder suicide: A murder suicide is an act in which an individual kills one or more other person immediately before or at the same time as him or herself. The motivation for the murder in murder-suicide can be purely criminal in nature or be perceived by the perpetrator as an act of care for loved one in the contacts of severe.

3.    Suicide attack: It mean when an attacker perpetrates an act of violence against other, typically to achieve a military or political goal that result in his or her own death as well. Suicide bombing are often regarding as an act of terrorism.

4.    Mass suicide: Some suicide is done under peer pressure or as a group. Mass suicide can take place with as few as two people, in a “suicide pact”, or with a large number of people. Suicide pact: A suicide pact describe the suicide of two or more individual in an agreed upon plan. The plan may be to die together, or separately and closely timed. Suicide pact is generally distinct from mass suicide. The letter to incidence in which a large number of people kill themselves together for the same ideological reason, often within a religious, political, military or paramilitary context. Suicide pacts, on the other hand, usually involve some groups of people (such as married or romantic partner, family members, or friends) whose motivation are intensely personal and individual.

There are certain other terms to be mention regarding suicide before discussion:-

Suicide Attempt: This involves a serious act, such as taking a fatal amount of medication and someone intervening accidentally. Without the accidental discovery the individual would be dead.

Self–harm: Suicide harm is not a suicide attempt because there is non-casual correlation between self harm and suicide; both are most commonly a joint effect of depression.

Suicide gesture: this denotes a person undertaking and unusual, but not fatal, behavior as a cry for help or to get attention.

Suicide equivalent: in this situation the person does not attempt suicide. Instead, he or she uses behavior to get some of the reactions their suicide would have caused. For example, an adolescent boy runs away from home. He wants to see how his parents respond. Do they care? Are they sorry for the way that they have been treating him? It can be seen as an indirect cry for help.

RISK FACTORS

A number of factors associated with the risk of suicide including mental illness, drug addiction, and socio economic factors. While external circumstances, such as traumatic event, may trigger suicide it does not seem to be an independent cause.

Mental illness or psychotic disorders:

 Mental disorders are frequently present at the time of suicide with estimate from 78% to 98%. When broken down in to type mode disorder or present in 30% in substance abuse in 80% schizophrenia in 14% and personality disorder in 13.0% of suicide. About 5% of people with schizophrenia die of suicide.

Obsessive-compulsive disorder (OCD) and phobic disorder have symptoms that make suicide a possibility.

Posttraumatic stress disorder:  Survivor of trauma, whether it is childhood sexual abuse or a recent physical devastation, struggle with flashbacks and nightmares. They frequently alternate between periods of hyper-vigilance and periods numbing. Veterans of Iraq and Afghanistan experience a high rate of PTSD and have a historically high rate of suicide. They have feeling of being damaged and feeling of guilt. As a result, they have a high rate of suicide.

Delirium and dementia; Delirium and dementia involve loss of memory, disorientation, and hallucinations, delusions and poor judgment. These conditions often lead to self-destructive behavior.

Substance abuse:

It is the second most risk factor for suicide after mood disorders. Both chronic substance misuse as well as acute substance is associated with suicide. More than 50% of suicides are related to alcohol a drug use. Up to 25% of suicides are committed by drug addicts and alcoholics. In adolescents the figure is higher with alcohol or drug misuse playing a role in up to 70% of suicides.

Substances contribute to self-destructive behavior in all 3 phases of their usage intoxication, withdrawal and chronic usage. A depressed person commonly becomes acutely suicidal after a few drinks. Similarly, some people can become suicidal after ingesting lysergic acid diethylamide (LSD). Others encounter a depression during substance withdrawal and respond with killing themselves. A person with chronic alcohol and drug use often experience a number of major losses, such as a job, spouse, and family and these in turn contribute to becoming suicidal. Even those in drug recovery programs remain at risk. For example, persons in opiate dependency programs, especially those with chronic pain, those with the availability of firearms, those using other street drugs and those new to the program are at particular risk. Disposition from emergency department visits for drug-related suicide attempts, 2004 (national estimates). Data from Drug Abuse Warning Network. Women with substance use disorders have an increased risk for suicide.

Cocaine:

Misuse of drugs such as cocaine has a high correlation with suicide in San Digo it was found that 30% of suicides in people under the age of 30 had used cocaine. In New York City during a crack epidemic one in 5 people who committed suicide were found to have recently consumed cocaine. The come down from cocaine can result in intense depressive symptoms coupled with other distressing mental effects with serve to increase the risk of suicide.

Opioids: Heroines user have a death rate 13 times that of their peers and death among heroin user are 14 times more likely then peers to die from suicides. Major depressive disorder was found in 20% of entrant to treatment for heroin dependence in Australia.

Alcohol:

Alcohol misuse is associated with number of mental health disorder and alcoholics have a very high suicide rate. It has been found that drinking 6 drinks are more per day results in a six fold increased risk of suicide.

Cigarette smoking:

 There have been various studies done showing a positive link between smoking, suicidal ideation and suicide attempts in a study conductive among nurses, those smoking between 1-24 cigarette per day had twice the suicide risk; 25 cigarette are more, four time the suicide risk, then those who has never smoke. In a study of 300,000 male us army soldiers, a definitive link between suicide and smoking was observed with those smoking over a pack a day having twice the suicide rate of non smoker.

Genetics:

Genetics has an effect on suicide risk accounting for 30% to 50% of variance. Some authorities believe that genetic factors alone may be involved, that suicide runs in families and that having a relative who commits suicide is indeed a risk factor. Therefore, a family history of suicide is very significant. Careful assessments of family history of mental illness and suicide should be a routine aspect of patient evaluation. Studies continue to show the gene connection in suicidal behavior. Genes related to serotonin have be implicated in histories of second suicide attempt. Certainly, many of the above listed mental illnesses (e.g. manic-depressive illness) are not only risk factors, but also have strong genetic components.

Gambling:

 Gambling is often associated with increase suicidal ideation and attempts compared to the general population. Early onset of problem gambling increases the life time risk of suicide. However, gambling related suicide attempts are usually made by older people with problem gambling. A 2010 Australian Hospital study found that 17 of suicidal patient admitted to Alfred Hospital’s emergency department were problem gambler.

Biological:

Genetics has an effect on suicide risk accounting for 30% to 50% of variance. Much of this relationship acts through the heritability of mental illness. There is also evidence to suggest that if a parent has committed suicide, it is strong predictor of suicide attempts among the offspring.

Suicide as an escape:

According to people in some situation where continuing to live is intolerable, some people use suicide as a mean of escape such as Nazi concentration camps are known to have killed themselves by deliberately touching the electrified fences.  Some people commit suicide after committing a crime to avoided prosecution and disgrace such as in murder-suicide. Nazi leader Hermann Goring, a high ranked Nazi and head of Luftwaffe, committed suicide with cyanide capsule rather than be hanged after his conviction at the Nuremberg Trials. 

Other suicide risk factor:

There are some other factors that have effects on suicide risk such as unemployment, poverty, homelessness, social economics, factors and discrimination made trigger suicidal thoughts. Poverty may not be a direct cause but it can increase the risk of suicide, as it is major risk group for depression. One study found that a lack of social support, a deficit in feeling of belongingness and living alone were crucial predictors of a suicide attempt.

Individuals who are suicidal have a number of characteristics, including the following:

·         A preoccupation with death.

·         A sense isolation and withdrawal.

·         Few friends or family

·         An emotional distance from other.

·         An emotional distance from other.

·         Distraction and lack of humor: They often seem to be “in their own world” and lack a sense of humor (anhedoni).

·         Focus on the past: They dwell in past losses and defeats and anticipate no future. They voice the notion that other and the world would be better of without them.

·         They are haunted and dominated by hopelessness and helplessness. They are without hope and therefore cannot foresee things ever improving. This is a terrible feeling. They also view themselves as helpless in 2 ways. First, they cannot help themselves. All their efforts to liberate themselves from the sea of depression in which they are drowning are to no avail. Second, no one else can help them.

METHOD OF SUICIDE:

Suicide method are dramatically varies from country to country, district to district and community to community. The leading methods in different region include hanging fire arm, bloodletting, intentional drowning, self immolation, electrocution, intentional starvation, blunt force (jumping from a building or bridge, self defenestration, stepping in front of a train or car collision) and the most common in district Mianwali is pesticide poisoning.

Prevention:

Suicidal prevention is term use for the collective efforts of one group from community to eliminate suicidal death. Such as first exclusive professional research centre was established in 1958 in LOS angles. The first rises hot line service in the US run by selected, trained citizen volunteer was established in 1961 in San Francisco.

Role of psychiatrist:

            Psychiatrist and a clinician have got the major role in prevention of rising ratio of suicide. It is the duty of the family and community to take all those to seek clinical advice from a psychiatrist whom they feel have any kind of suicidal ideation. Clinical sessions to psychiatrists are the key to the betterment of these patients. During these regular sessions a clinician can assess the changing behavior of the patient so e can either admit the patient or can alarm the family member to keep an eye on patient’s day to day routine as the psychiatrist can evaluate the rising urge of suicide in the patient’ even if he himself is not accepting it publically. Drug users should be consulted to psychiatrist as a rule or should be admitted to rehabilitation center. A suicide at-tempter should also be consulted to a psychiatrist to avoid future successful attempt. Even during treatment if patient commit suicide, psychiatrist should visit his house and should collect data and details of his activities and behavior just before suicide. This all will help the psychiatrist to reschedule the plans for rest of his patients and this effort will benefit other patients.

to be continue