Suicide is a public, yet very personal, health problem. It impacts not only those who attempt or commit suicide, but also their surviving friends and family, leaving them heartbroken, with unanswered questions and feelings of devastation and guilt. Aside from the enormous emotional toll, suicide is associated with economic and medical costs for the individuals involved and healthcare in general.
What makes suicide so utterly devastating is that it is one of the most preventable causes of death. Depression, PTSD, chronic pain, substance use, and other mental ailments do not have to result in suicide. In my three years of being a psychiatric nurse, I have cared for many post suicide attempt patients, as well as the ones having suicidal thoughts. The reality is – the majority of them did not want to die. They just wanted the pain to stop, whether it was physical or emotional pain, unbearable depression, or PTSD symptoms.
First responders’ repeated exposure to human pain, suffering, and death, combined with long work hours, lack of sleep, hectic schedule, inability to debrief and recover between the calls predispose them to developing anxiety, depression and PTSD, which could contribute to thoughts of suicide if left untreated. According to Suicide Prevention Resource Center (SPRC), police officers and firefighters are more likely to die by suicide than in the line of duty.
First responders can do a few things to protect their own mental health (e.g., be more aware of signs of compassion fatigue in themselves and others, support one another, encourage clear communication, and use counseling services as needed). But that’s not enough. Having certain policies in place will ensure that first responders are getting the help they need to maintain their mental health.
As Longest (2014) points out in his book, public policymaking process is run and controlled by people who bring their own ethics to the table. “Ethical considerations help shape and guide the development of new policies by contributing to definitions of problems and the structure of policy solutions” (Longest, 2014, pp. 52-53). Ideally, the ethical behavior of all policymakers should be guided by the philosophical principles of respect for the autonomy of other people, justice, beneficence, and nonmaleficence.
The first philosophical principle, respect for autonomy, pertains to the rights of individuals to determine how they live their lives, including the integrity of their bodies and minds (Longest, 2014). While most people would agree that respecting people’s autonomy is important, it does not substantiate the “right to die”, especially when the individual has underlying mental conditions (i.e. anxiety, depression, PTSD, substance abuse) caused by the hazardous environment of their job (Clark, D., 1999). Being aware of the problem, talking about it with colleagues and counselors, getting the help needed in a timely manner would get the mental issues under control and decrease thoughts of suicide in first responders.
Justice, the second philosophical principle guiding the policymakers, is the foundation of all healthcare policies. It includes distributive justice which ensures fair distribution of health-related benefits and burdens (Longest, 2014). Implementing policies intended to provide more mental health resources to people who need them the most (e.g., first responders) would be an example of egalitarian perspective of the justice principle.
Beneficence in healthcare policy and decision-making, as related to suicide prevention among first responders, would be evident in policymakers acting with kindness and charity, and seeking to do good for the first responders (Longest, 2014).
Policy makers guided by the fourth philosophical principle, nonmaleficence, would be making decisions that minimize harm to the first responders (Longest, 2014).
Policy makers must remember that their ethical considerations shape and influence new policies that affect real people. Their ethical behavior must always be guided by the four philosophical principles, and their decisions must be based on what’s in the best interest of the constituents (Longest, 2014).
References
Clark, D. (1999). Autonomy, rationality and the wish to die. Journal of Medical Ethics 1999; 25:457-462
Longest, B. (2014). Health policymaking in the United States (5th ed.) AUPHA, Arlington, VA.
Suicide Prevention Resource Center (2020). Retrieved from https://www.sprc.org/news/why- suicide-top-cause-death-police- officers-firefighters
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