Is passive, personal neglect a form of suicide?
One of my jobs in lower extremity health is limb salvage. I had completed a forefoot amputation on a patient several weeks ago for osteomyelitis (bone infection). In the course of recovery, I got to know a wonderful man who was full of laughter and stories about rural life in western Colorado. He was most proud of his work in the bauxite industry, something that was unfamiliar to me. He described for me the uses of bauxite in the agricultural industry.
But interestingly, as I learned more about my patient’s personal life, I learned that he had a long history of self-neglect. He had been in and out of wound care clinics due to diabetic wounds of both feet. I spoke with his wound care nurse who told me about how he had grown increasingly despondent, had not cared about his rapid increase in weight and refused to participate in his personal care. His weight was now close to 300 lbs.
I also had the pleasure to get to know his wife and daughter. You could tell that the family had been very close over the years, but the patient’s refusal to care for himself was tearing the family apart. His wife was unable to personally care for him. The only solution to save the family was to institutionalize the patient.
In speaking to our hospitalist team who also cared for the patient, they used a term that I was unfamiliar with: passive suicide.
What are the factors that contribute to passive suicide? In an article entitled, ‘What cognitive functions are associated with passive suicidal ideation? Findings from a national sample of community-dwelling Israelis’ by Ayalon and Witman, they look at the cognitive domains associated with passive suicide ideation. (1) Interestingly, they relate time orientation as a factor in an aging population that is most closely associated with passive suicide ideation.
I’ll be sure to lose track of this patient over the next few months as his need for lower extremity care starts to wane. But I won’t forget how he and so many other patients I have seen over the years neglected themselves. I used to call this a death spiral – increased weight gain from inactivity leads to increased weight loss resulting in hypertension, diabetes, and osteoarthritis of the knees. Now I know better. It’s actually more than a passive death spiral, it’s better described as passive suicide.
- Ayalon L, Litwin H. What cognitive functions are associated with passive suicidal ideation? Findings from a national sample of community-dwelling Israelis. Int J Geriatr Psychiatry. 2009 May; 24(5): 472–478.