It is a rare clinician, specialising in mental health, whose working life has been left untouched by the suicide of a person in whose care they were involved. As its title suggests, this useful and interesting book is aimed at the practical concerns of clinicians, policy makers and researchers who are faced with ethical challenges when working to prevent suicide with either individuals or at a service level.

The book’s initial, and most broadly applicable, chapter examines ethical perspectives that guide decision-making around suicide. Three broad ethical paradigms are set out: moralist (suicide is unacceptable and there is a moral obligation to protect life), libertarian (which emphasises an individual’s freedom of choice) and relativist (where what is morally acceptable is governed by context).

Informative chapters follow on areas including moral dilemmas in helpline rescue policies, ethical challenges in suicide research and suicide and civil commitment. Ethical quandaries are examined with reference to the three aforementioned philosophical viewpoints via case studies. With the stated objective of stimulating debate, the authors do not shy from occasionally making their own opinions clear but are careful to give all viewpoints space.

The book’s concluding chapters tackle ethical and legal issues pertinent to assisted suicide and medical assistance in dying. With the passing, in November 2024, of the UK Parliament’s Terminally Ill Adults (End of Life) Bill these could hardly be more topical for a UK-based audience. However, whilst illuminating, the focus of the discussion on these interrelated subjects is often directed towards the situation in Canada – from whence the authors hail – and this may limit its interest and applicability to a UK-based audience.

This will be more of dip-in, rather than read-through, book for most. However, those tackling it front-to-back will find their investment rewarded. It is academically rigorous, yet readable and clear, and assumes little prior knowledge. I initially assumed the chapter on genetic testing for suicide risk assessment would have little relevance to my practice. Indeed, as Mishara and Weisstub themselves conclude, it is ‘unlikely that genetic testing will be able to reliably help identify people at risk of suicide’. Yet, they also note valuably that genetic testing provided direct to consumers by private companies is increasingly popular and, in clinics, psychiatrists may find themselves asked to advise on such results.

To what degree should we intervene to save a life? When should autonomy be respected? Many ethical questions pertinent to suicide are challenging to resolve. Yet approach them we must: as the authors note in this book’s preface, 700 000 people die worldwide by suicide each year. Psychiatrists report that the death of a patient by suicide can affect their emotional well-being, their functioning at work and their personal lives. A better knowledge of ethics will not inoculate against such distress, but by guiding exploration of the moral territory surrounding suicide, this book may help assure practitioners that they have necessary knowledge to cope.