Second Colloquium on Ethics of "Active Intervention" Policies of Suicide Prevention Call Centers

By The Beacon | November 2, 2011 9:00pm

By Loren Sickles, Guest Contributor, Sickles13@up.edu

Questioning the ethical justification for "active intervention" policies of suicide prevention crisis lines, Dr. Norah Martin presented her recently published research titled "Preserving Trust, Maintaining Care, and Saving Lives: Competing Feminist Values in Suicide Prevention." Martin, Associate Dean of CAS and Professor of Philosophy, presented on Oct. 25 as the second presenter in several scheduled lectures in the new colloquia series sponsored by the Communication Studies Department.

In keeping with the "Interdisciplinary Scholarship" theme of the series, Martin, applying a feminist bioethical perspective, focused on the tension created by suicide prevention telephone crisis centers' marketing claims of confidentiality and the industry's standard practice of active intervention. In the crisis line industry, active intervention is when a call center counselor determines that the caller is in a potentially lethal situation, (e.g., holding a loaded gun) and notifies police without the caller being informed. Martin recounted in her talk a situation, described in her paper, where active intervention was employed. "My concern here is with the practice of active intervention overall," Martin states in her paper.

Throughout her talk Martin raised the issue of client confidentiality being compromised when emergency services are called to intervene without the client's consent, or knowledge, that such action may be taken. "I went to the talk believing that if someone calls a suicide prevention hotline and sounds like they are seriously threatening to end their life," said graduate student Anna Lageson, "that a therapist/volunteer should do anything possible, and use any means necessary to prevent the loss of [that] life." Martin contended that this policy of no explicit informed-consent is not in keeping with other forms of face-to-face counseling where the client is informed at the beginning concerning the limits of confidentiality, what the counselor's obligation is to report, and the client's right to refuse service. "I didn't know that the suicide help lines were being advertised as confidential but were not truly following through with this advertisement," graduate student Melissa Boles said.

Martin said her interest in this issue of confidentiality and active intervention stems from a conference she attended for the American Association of Suicidology (AAS). AAS is an organization that has established standards for the crisis call center industry and maintains an accreditation process that provides national recognition for member call centers. Martin discovered that in order for a crisis call center to be accredited by AAS they are required to practice active intervention. Under this practice, when an individual calls a crisis line, if anything is said or done that causes the counselor to believe the caller is in imminent danger of suiciding*, the counselor must call 911 and does not need to inform the caller. Based on a belief that a life must be saved at all cost, AAS and the industry have determined that, as Martin wrote in her paper, "it is more important that we saved the person's life than that we have maintained an honest relationship with her." Martin's line of inquiry questioned whether this approach justifies the "abandonment of other moral goods," including the possible violation of trust that may have developed between the caller and the counselor. "Now that I've heard Dr. Martin's presentation, I see that this situation is not so black and white," Lageson said. "Though we want to save a life, must we deceive and manipulate to do so?" In her paper, Martin outlined a number of policy changes that would help to minimize violation of trust as it develops between a person in crisis and the call center worker.

In her opening remarks, Martin raised the issue of the terminology used to talk about suicide. She challenged audience members to think of suicide as a verb, as in "to suicide" or "suicided," rather than the common "to commit suicide." "By using ‘to commit suicide' one is coding suicide as morally odious and thus by implication that the person who does it as a bad person." Martin clarified later, "By referring to it as "to suicide" we make the act morally neutral." This is significant when considering family that may be dealing with the loss, by changing the terms used, suicide intervention communities believe they will be able to "destigmatize the act," claimed Martin. Reflecting on the series in general, Boles believes that "It gives students/staff members the opportunity to learn something from someone in a different department than their own." Specific to Martin's talk, Boles said, "her [Martin's] lecture really challenged me to think more about suicide prevention in general, and it made me want to read her paper."

Martin's essay was published in the "International Journal of Feminist Approaches to Bioethics, Vol. 4, No. 1, Spring 2011;" a copy of the article is available to faculty, staff, and current students through UP Illiad.

The last fall term presentation in the colloquia series is scheduled for Nov. 16 and, according to colloquia series organizer Dr. Courtney Fletcher, will highlight the research titled "HIV Prevention in At-Risk Populations" by Dr. Travis Lovejoy, Ph.D., M.P.H., Health Psychology Fellow at the Portland VA Medical Center.


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