SUICIDE/Parasuicide

244 SUICIDE/Parasuicide

end-of-life practices. Since 1995, the demand for physician-assisted death has not risen among patients (0.3% of all deaths in the Netherlands), and physi- cians seem to have become somewhat more reluctant in their attitude towards this practice. Even if assisted suicides are not so frequent, 57% of all medical doc- tors in the Netherlands have performed euthanasia or physician-assisted suicide since the law was imple- mented. How this phenomenon can be considered according to the ethical code of medical doctors is a major ethical debate, now widely discussed in many developed countries.

See Also

Autoerotic Death; Deliberate Self-Harm, Patterns; Fo- rensic Psychiatry and Forensic Psychology: Suicide Predictors and Statistics; Murder–Suicide; Suicide: Parasuicide; Youth Suicide

Further Reading

Charlton J, Kelly S, Dunnell K, Evans B, Jenkins R (1993) Suicide deaths in England and Wales: trends in factors associated with suicide deaths. Popuation Trends 71: 34–42.

Chesnais J-C (2003) Les morts violentes dans le monde. [Violent deaths in the world.] Population et Socie ́te ́s 395: 1–4.

De Leo D, Scocco P, Marietta P, et al. (1999) Physical illness and parasuicide: evidence from the European Parasuicide Study Interview Schedule (EPSIS/WHO-EURO). Interna- tional Journal of Psychiatry and Medicine 29: 149–163.

DeVivo MJ, Black KJ, Richards JS, Stover SL (1991) Suicide following spinal cord injury. Paraplegia 29: 620–627. Hawton K (2000) Gender differences in suicidal behaviour.

British Journal of Psychiatry 177: 546–550. Hepple J, Quinton C (1997) One hundred cases of attempted suicide in the elderly. British Journal of Psychiatry 171:

42–46. Kleespies PM, Hughes DH, Gallacher FP (2000) Suicide in

the medically and terminally ill: psychological and ethi- cal considerations. Journal of Clinical Psychology 56: 1153–1171.

Knight B (1991) Murder, suicide or accident? In: Arnold E (ed.) Simpson’s Forensic Medicine, 10th edn., pp. 117– 127. London.

Kreitman N, Carstairs V, Duffy J (1991) Association of age and social class with suicide among men in Great Britain. Journal of Epidemiology and Community Health 45: 195–202.

Lewis G (1998) Suicide, deprivation, and unemployment: record linkage study. British Medical Journal 317: 1283–1286.

Marc B, Baudry F, Zerrouki L, Ghaiath A, Garnier M (2000) Suicidal incised wound of a fistula for hemodialysis access in an elderly woman. American Journal of Forensic Medicine and Pathology 21: 270–272.

Marzuk PM, Leon AC, Tardiff K, et al. (1992) The effect of access to lethal methods of injury on suicide rates. Archives of General Psychiatry 49: 451–458.

Onwuteaka-Philipsen BD, Van der Heide A, Koper D, et al. (2001) Euthanasia and other end-of-life decisions in the Netherlands in 1990, 1995, and 2001. Lancet 362: 395–399.

Sainsbury P (1986) The epidemiology of suicide. In: Roy A (ed.) Suicide, pp. 17–40. Baltimore, MD: Williams and Wilkins.

Shah A, Hoxey K, Mayadunne V (2000) Suicidal ideation in acutely medically ill elderly inpatients: prevalence, corre- lates and longitudinal stability. International Journal of Geriatric Psychiatry 15: 162–169.

Parasuicide

R Nathan, Merseyside Forensic Psychiatry Service, St Helens, UK K J B Rix, Leeds Mental Health Teaching Trust, Leeds, UK

ß 2005, Elsevier Ltd. All Rights Reserved.

Introduction

The term ‘‘parasuicide’’ embraces an enormous vari- ety of behaviors. Between 1 and 5% of respondents to community surveys in the USA and Europe have deliberately harmed themselves, although higher rates have been reported. The problem of parasuicide is especially pressing in forensic populations. Rates among offenders are significantly elevated and the management of parasuicide in forensic settings poses particular difficulties. Furthermore, courts may be more likely to seek the evidence of an expert witness when the proceedings relate to an individual with a history of parasuicide.

Definition

The clinical judgment as to whether an event such as a deliberate overdose or self-laceration represents para- suicide is usually straightforward. However, given the different types of actions and intentions, a single de- scriptive term that can be applied universally has proved elusive. ‘‘Attempted suicide’’ suggests suicidal intent, which cannot be assumed. ‘‘Suicidal behavior’’ covers suicide and attempted suicide, but is often used more broadly to describe all fatal and nonfatal delib- erate self-harm. Although ‘‘deliberate self-harm’’ does not refer to suicidal intent, it implies harm, which is not a necessary condition. A deliberate overdose should not be excluded from consideration because either the individual unwittingly took too low a dose