Three distinct forms of suicide may be identified based on the role that a clinician plays in the process: 1. 2. 3.

Unassisted Suicide Facilitated Suicide Assisted Suicide

Unassisted Suicide This may take two forms. The first applies where the victim completes suicide while not currently or recently in the care of a clinician. The second applies where the victim was currently under care but not for a condition associated with suicidality. The clinician had no basis to assume or suspect risk. The victim did not confide any ideation, plan, or threat or did not acknowledge such behavior if queried by the clinician. Facilitated Suicide This applies where the victim completes suicide while currently or recently in the care of a clinician and where these factors were present: A clinical or custodial relationship existed The clinician or provider had knowledge of the risk Means of prevention or intervention were available A suicide in this context suggests a breach of duty. This could include ignoring the danger, and/or not effectively using resources that may have ameliorated the risk. In such cases, the suicide has, in effect, been facilitated. This is not to say that the clinician caused the suicide. The ethical failing was doing nothing or acting passively or conservatively despite the client's mortal danger. Assisted Suicide This applies where a clinician with knowledge of the individual's wishes and consent enables completion by providing the lethal means and guidance as to use. This mode assumes capacity and rationality. However, most victims of assisted suicide appear driven by extreme stress and/or chronic intractable pain which impair capacity and rationality. Enabling the suicide of such individuals, statutes to the contrary, is unethical. Volition and Suicide Assisted suicide is justified, by its advocates, as a personal right. Unassisted suicide is customarily characterized as a personal decision. Where does that leave facilitated suicide? Consider the following: Assisted Suicide = Voluntary Action Facilitated Suicide = Involuntary Action Unassisted Suicide = Nonvoluntary Action

Assisted suicide is voluntary when the individual is determined to be capable of independently making the decision. Facilitated suicide is involuntary because the individual made a "cry for help" to a clinician that went unheeded. Unassisted suicide is nonvoluntary in the same way that death as the result of any disease is so. A somewhat similar typology is offered by Fairbairn (1995)in Contemplating Suicide: The Language and Ethics of Self-Harm: The most obvious variety of a suicide act involves the suicide actively bringing harm to himself. However, suicide may also be achieved by the direct action of another, by the omissions to act of either the suicide or another, and by the suicide's putting himself in the way of events that he intends and expects to kill him.