CONTEXT: Previous studies have reported significantly elevated standardised mortality rates in older people with cancer. Terminally ill people represent a unique group where suicide may be considered as rational.
OBJECTIVES: The aims of this study are to (i) compare the socio-demographic and clinical characteristics of older people with and without terminal cancer who died by suicide, and (ii) analyze the suicide motives of those with terminal cancer to determine whether they represent rational suicide.
METHODS: The New Zealand Coronial Services provided records of all older people (age≥65) who died by suicide between July 2007 and December 2012. Socio-demographic and clinical data were extracted from the records. Using the characteristics for defining rational suicide, we determined whether the motives in terminal cancer cases represented rational suicide.
RESULTS: Of the 214 suicide cases, 23 (10.7%) older people were diagnosed with a terminal cancer. Univariate analysis found older people with terminal cancer who died by suicide were less likely to have a diagnosis of depression (8.7% versus 46.6%, p=0.001) or previous contact with mental health services (4.5% versus 35.0%, p=0.004) than those without terminal cancer. 82.6% of the terminal cancer cases had a motivational basis that would be understandable to uninvolved observers.
CONCLUSIONS: A high proportion of those with terminal cancer had motives suggestive of rational suicide. Future studies are needed to clarify whether the low rate of depression is secondary to under-diagnosis of depression or people with terminal cancer choosing to end their life as a rational act to alleviate suffering.