Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Mar 22, 2015; 5(1): 4-14
Published online Mar 22, 2015. doi: 10.5498/wjp.v5.i1.4
Culturally sanctioned suicide: Euthanasia, seppuku, and terrorist martyrdom
Joseph M Pierre
Joseph M Pierre, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, VA West Los Angeles Healthcare Center, Los Angeles, CA 90073, United States
Author contributions: Pierre JM solely contributed to this manuscript.
Conflict-of-interest: The author reports no conflicts of interest in relation to this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Joseph M Pierre, MD, Health Sciences Clinical Professor, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Building 210, Room 15, Los Angeles, CA 90073, United States.
Telephone: +1-310-4783711 Fax: +1-310-2684448
Received: September 28, 2014
Peer-review started: September 29, 2014
First decision: December 17, 2014
Revised: December 21, 2014
Accepted: January 15, 2015
Article in press: January 19, 2015
Published online: March 22, 2015

Suicide is one of the greatest concerns in psychiatric practice, with considerable efforts devoted to prevention. The psychiatric view of suicide tends to equate it with depression or other forms of mental illness. However, some forms of suicide occur independently of mental illness and within a framework of cultural sanctioning such that they aren’t regarded as suicide at all. Despite persistent taboos against suicide, euthanasia and physician-assisted suicide in the context of terminal illness is increasingly accepted as a way to preserve autonomy and dignity in the West. Seppuku, the ancient samurai ritual of suicide by self-stabbing, was long considered an honorable act of self-resolve such that despite the removal of cultural sanctioning, the rate of suicide in Japan remains high with suicide masquerading as seppuku still carried out both there and abroad. Suicide as an act of murder and terrorism is a practice currently popular with Islamic militants who regard it as martyrdom in the context of war. The absence of mental illness and the presence of cultural sanctioning do not mean that suicide should not be prevented. Culturally sanctioned suicide must be understood in terms of the specific motivations that underlie the choice of death over life. Efforts to prevent culturally sanctioned suicide must focus on alternatives to achieve similar ends and must ultimately be implemented within cultures to remove the sanctioning of self-destructive acts.

Keywords: Suicide, Euthanasia, Martyrdom, Physician-assisted suicide, Seppuku, Hara-kiri, Terrorism, Culture

Core tip: Although most cultures have taboos against suicide, some acts of suicide find moral justification and approval in different cultural settings. These acts typically occur independent of mental illness and are regarded as something other than suicide per se. Strategies for prevention therefore require the development of other culturally sanctioned alternatives.