I recently heard this story from a veteran of the Vietnam War. It would probably be best not to reveal his identity, so here I'm going to call him
Allen.
Allen worked as a medic towards the end of the war. Once the war was technically over, there were still 60,000 men who remained in the military finishing out their service. During this time, Allen worked with the psychiatric unit. As one can imagine, there were a lot of men who were suffering from all sorts of psyciatric problems at the close of the conflict, including hundreds at risk for suicide. Allen was one of only a handful of medics who were assigned to deal with all psychiatric issues, and he and the others were overwhelmed by the number of people seeing them who were suicide risks. There simply was not enough time or resources to treat every patient, and decisions had to be made about who should be referred to the staff psychiatrist, who needed talk therapy, and who really just needed time.
Before I go on, a few words on Valium. Valium was the psychiatric drug of choice at the time, used to treat anxiety, insomnia, and other problems. One reason it was popular with doctors is that it is almost impossible to kill yourself by ODing on it. However, the difference between the amount you have to take to become temporarily comatose is not so high. Because of this, a person trying to kill themselves by taking lots of 35mg pills would pass out before they were able to take enough to OD.
Back to the story. In order to solve their resource allocation problem, Allen and the others needed some kind of triage system to identify which of their patients were at the highest risk. The solution to this problem ended up being Valium. When a man would come in complaining of severe depression or suicidal thoughs, Allen would do his best to talk to him first, saying that things would get easier as time passed, and so on. Then, he would offer a month's worth of Valium, saying that, "Valium is an antidepressant. If you take it every morning, it is going to take some of the edge off of your day and make it easier to cope with the stress you're feeling."
He would go on, saying, "This is a very powerful drug. You have to be careful not to take the entire month's supply of pills at once. If you do, you will go asleep and never wake up."
When the patient left with the pills, Allen would then call the man's commanding officer. He would advise the officer to make sure that the soldier reported for duty as expected every morning at 8:30. If the man did not report, the officer was to send someone to the bunks to check up on him.
What Allen and the others had done was create a way to test how serious a patient was about comitting suicide. If the man just needed a drug to take the edge off and some time, the treatment he prescribed would do the trick. If the patient really was about to take his own life, Allen appeared to offer him an easy, painless way to do it. Go to sleep and never wake up. What the patients didn't know is that they would wake up. If this happened, they were referred to recieve the more serious care they needed.
Was this course of treatment ethical? I doubt any doctor would say yes. But while Allen worked this psych rotation, not one person successfully killed themself.
