By Tessa Jane Holzman
On 24 June 2025, the Australian Productivity Commission released an interim report evaluating the National Mental Health and Suicide Prevention Agreement. This report paints a scathing picture of the state of the Agreement. While the PC’s recommendations are certainly important components of a robust national strategy for mental health and suicide prevention, they remain incomplete.
Currently, the dominant paradigm in terms of suicide prevention frames it as a matter of public health. It is taken for granted that all deaths by suicide should be prevented, purely due to the fact that death should be prevented (similarly to how all deaths from cancer should be prevented).
However, this approach to suicide prevention fails to acknowledge a key difference between suicide and other threats to public health and safety; the fact that suicide is a self-directed act that involves some level of choice. People do not choose to develop cancer in the same way that they choose to take their own lives, and this distinction raises important ethical questions that are unaddressed by the dominant approach to suicide prevention.
A more nuanced and practically oriented approach might frame suicide prevention as the prevention of bad deaths. Of course, every effort should be made to improve the circumstances that have driven a person to suicidal ideation, but there should also be an acknowledgement that sometimes suicide is a rational and suitable choice. In these cases, it is essential that adequate end-of-life care is offered, allowing these individuals the opportunity to die safely and calmly instead of being forced to select potentially violent or otherwise distressing methods of ending their lives. When a wish to die has proven to be rational and reasonable, taking a Zero Suicide approach may counterintuitively expose that individual to harm by forcing her to undergo a different, less desirable death.
This position was recently criticised by Susan Pennings in a response to the original current controversy piece making this argument. A key point in Pennings’ argument is that suicide prevention policy has an important expressive function, and that taking a public health approach is valuable because it expresses that all human life is meaningful and worthwhile and should not be understood to only have instrumental value. There was a further concern that incorporating assisted dying options into a national suicide prevention scheme could be understood as the government endorsing the worthlessness of certain kinds of lives.
This touches on a larger discussion about the continued suitability of a public health approach as values of autonomy, individuality, and self-determination increasingly take centre stage within the medical field. Indeed, suicide prevention policy has an inevitable expressive function; that is not under debate. Rather, the question is what the policy should be expressing. In the age of precision medicine, a growing understanding of the social determinants of health, and an increasing appreciation for individuals as experts on their own lived experiences, a one-size-fits-all public health approach that insists that all life is worth living no matter what seems a little patronising at best and outright dishonest at worst.
Forcing a life on someone who does not want it will not bring them hope or encouragement. In all likelihood, it will make them feel isolated and ignored, which is completely counterproductive for an already very vulnerable group. What is much more likely to be comforting is to take the individual seriously, to acknowledge the gravity of their situation, and to reassure them that while every effort will be made to help them return to a worthwhile and enjoyable life, they will not be abandoned and left to their own devices if this proves not to be possible. The real question here is whether the blunt tool of public health messaging is able to express such a complex and nuanced ideology, and what this means for the viability of public health at large.
Paper title: Suicide is not a public health issue and perhaps very few things should be
Authors: Tessa Jane Holzman1, Julian Savulescu2
Affiliations: Charles Sturt University1, National University of Singapore2, Oxford University2
Competing interests: None declared