Moral perspectives on the prevention of suicide in mental health settings

The Googlization of Health: Invasiveness and corporate responsibility in media discourses on Facebook's algorithmic programme for suicide prevention

Big tech companies increasingly play a role in the domain of health. Also called the "Googlization of Health", this phenomenon is often studied by drawing on the notion of 'hostile worlds', where market values and common goods are incommensurable. Yet, the 'hostile worlds' theory is not uncontested; scholars for instance argue that the justifications of big tech companies are important analytical considerations as well. Building on this literature, in this paper I report on a case study of Facebook employing AI for suicide prevention, moving beyond Facebook's justifications only to study the ways in which media commentators and their audiences discussed Facebook's programme and the values they saw as being at stake. In the results, I show how invasiveness was, in different ways and forms, a main theme in thinking about Facebook using AI to do suicide prevention. Commentators and readers alike discussed how: 1) Facebook takes corporate responsibility with this initiative, or alternatively Facebook only has commercial interests and uses the notion of 'public good' to transgress spheres and sectors even further, thus being invasive; 2) Facebook's AI suicide prevention programme is invasive in relation to privacy and privacy laws, or, instead, people give up their privacy willingly in exchange for entertainment; 3) The programme undermines, rather than enhances, safety; 4) Suicide prevention in itself is already invasive. These different forms of invasiveness, I argue in the conclusion, also imply responsibility for different actors, from AI itself to Facebook through to medical professionals. Moreover, they show what values are at stake in, and transformed through, Facebook's AI suicide prevention programme, going beyond the frames of privacy and surveillance capitalism.

Technology for Our Future? Exploring the Duty to Report and Processes of Subjectification Relating to Digitalized Suicide Prevention

Digital and networking technologies are increasingly used to predict who is at risk of attempting suicide. Such digitalized suicide prevention within and beyond mental health care raises ethical, social and legal issues for a range of actors involved. Here, I will draw on key literature to explore what issues (might) arise in relation to digitalized suicide prevention practices. I will start by reviewing some of the initiatives that are already implemented, and address some of the issues associated with these and with potential future initiatives. Rather than addressing the breadth of issues, however, I will then zoom in on two key issues: first, the duty of care and the duty to report, and how these two legal and professional standards may change within and through digitalized suicide prevention; and secondly a more philosophical exploration of how digitalized suicide prevention may alter human subjectivity. To end with the by now famous adagio, digitalized suicide prevention is neither good nor bad, nor is it neutral, and I will argue that we need sustained academic and social conversation about who can and should be involved in digitalized suicide prevention practices and, indeed, in what ways it can and should (not) happen.

Beyond the Medical Model

The medical model continues to dominate research and shape policy and service responses to suicide. In this work we challenge the assumption that the medical model always provides the most effective and appropriate care for persons who are suicidal. In particular, we point to service user perspectives of health services which show that interventions are often experienced as discriminatory, culturally inappropriate, and incongruent with the needs and values of persons who are suicidal. We then examine “humanistic” approaches to care that have been proposed as a corrective to an overly medical model. We argue that the focus on improving interpersonal relations set out in humanistic approaches does not mitigate the prevailing risk management culture in contemporary suicide prevention and may impede the provision of more effective care. Finally, we draw attention to the tradition of non-medical approaches to supporting persons who are suicidal. Using Maytree (a U.K. crisis support service) as a case study, we outline some of the key features of alternative service models that we consider central to the design of more culturally appropriate and effective interventions. We conclude by making three key recommendations for improving services to persons who are suicidal.

Relational Principles in the Care of Suicidal Inpatients: Experiences of Therapists and Mental Health Nurses

This study explored and compared therapists' and mental health nurses' experiences of caring for suicidal inpatients in light of ethics of care and ethics of justice. Analysis of interview data from eight therapists and eight mental health nurses indicates two approaches: "connection and care" and "duty and control," reflecting aspects of both ethical perspectives. There are some differences between the two professional groups, and sometimes there might be conflicts between the two approaches and ethical perspectives. Clinical practice is increasingly shaped by standardization and guidelines, and it is important to promote professionals' efforts to provide relational-emotional care for suicidal patients.

Rational suicide, assisted suicide, and indirect legal paternalism

This article argues in favour of three related claims: First, suicide is not an immoral act. If people autonomously choose to kill themselves, this ought to be respected. Second, we can deem the desire to die comprehensible, and even rational, when the person contemplating suicide does not see a meaning in her life. This assessment is not based on a metaphysically dubious comparison between the actual life of a person and the supposed state of being dead. Third, from the first two theses it does not automatically follow that we should allow other people to help someone who autonomously and rationally chooses to die to pursue this plan. To argue against indirect legal paternalism, the practice of legally preventing someone else to assist a person to perform a suicide or to be killed on request, needs additional reasons. It is argued that assisted suicide and voluntary active euthanasia can indeed be justified by establishing a claim of persons who want to die but are not able to kill themselves. This mainly means that being really free to die should be interpreted as involving the means to fulfil one's desire to die.

Alleviating psychological distress of suicide survivors: evaluation of a volunteer care programme

The crisis level in the worldwide suicide rate has revealed a severe suicide problem in Taiwan that is now well above the world average of 16 per 100,000 individuals. Many countries have relied on suicide care volunteers training programmes to conduct suicide prevention programmes. However, there is a dearth of research evaluating the effect of volunteers on psychological distress and the impact of volunteer experience level. An evaluation of the impact of experienced and novice volunteers in alleviating psychological distress of suicide survivors was conducted. A supervised programme trained 15 volunteers at Years 1 and 2. Year 1 volunteers completed 400 h of service with continuing education. Programme evaluation occurred after Year 2 volunteers had completed training. Eighty-two suicide survivors were recruited. With 60 suicide survivors completing 3 month of volunteer care, a significant group difference with time interaction in suicide survivors who exhibited moderate to severe distress between the veteran care and novice care groups was found. Compared with novice volunteers, veteran volunteers with at least 1 year of experience are more effective with suicide survivors reporting higher psychological distress.

Three versions of an ethics of care

The ethics of care still appeals to many in spite of penetrating criticisms of it which have been presented over the past 15 years or so. This paper tries to offer an explanation for this, and then to critically engage with three versions of an ethics of care. The explanation consists firstly in the close affinities between nursing and care. The three versions identified below are by Gilligan (1982), a second by Tronto (1993), and a third by Gastmans (2006), see also Little (1998). Each version is described and then subjected to criticism. It is concluded that where the ethics of care is presented in a distinctive way, it is at its least plausible; where it is stated in more plausible forms, it is not sufficiently distinct from nor superior to at least one other common approach to nursing ethics, namely the much-maligned 'four principles' approach. What is added by this paper to what is already known: as the article tries to explain, in spite of its being subjected to sustained criticism the ethics of care retains its appeal to many scholars. The paper tries to explain why, partly by distinguishing three different versions of an ethics of care. It is also shown that all three versions are beset with problems the least serious of which is distinctiveness from other approaches to moral problems in health care.

Whose life is it anyway? An exploration of five contemporary ethical issues that pertain to the psychiatric nursing care of the person who is suicidal: part two

This is the second of a two-part paper which focuses on five principal issues/questions which can inform mental health nurses' ethical discourse around the matter of suicide. This second part focuses on the questions: is there such a phenomenon as a rational or appropriate suicide? And what role, if any, should mental health nurses occupy in assisted suicide? We find that the relevant theoretical and ethical literature in this area suggests, at least for some, that there may very well be such a phenomenon as a rationale suicide, especially if the often cited myth that all people who complete suicide must ipso facto have a mental health problem, is scrutinized. Furthermore, the extant literature indicates that while for the majority of suicidal acts, mental disorders may be a necessary but not sufficient element; the suicidal process is not, however, synonymous with mental disorder phenomenology. Lastly, whether or not there is a role(s) for mental health nurses in assisted suicide is difficult to say because there is almost no indication in the literature that such views have been solicited and considered. Given mental health nurses' often 'front-line' involvement in care of the person who is suicidal, there is an urgent need to canvass these views and include them in the debate. Lastly, given the content of current mental health nurses Codes of Ethics and Professional Codes of Conduct, there may be a need to revisit these codes in light of contemporary and changing views of assisted suicide.