Religious, Ethical, and Spiritual Considerations in Individuals Who Attempt Suicide by Intentional Poisoning: A Narrative Review
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 16 (2026),
1 Dey 2026
,
Page 1-12
https://doi.org/10.22037/ijmtfm.v16.53342
Abstract
Background: Substance use disorders (SUDs) significantly impact oral health, yet the pathophysiological mechanisms remain under-synthesized. This narrative review evaluates the clinical manifestations, diagnostic challenges, and management strategies for oral pathologies associated with SUDs.
Methods: A narrative review was conducted using the article's original literature base (1999–2025). The search strategy covered PubMed/MEDLINE, Google Scholar, ScienceDirect, SpringerLink, SID, Magiran, and NoorMags, supplemented by official primary-authority sources from Shi'a maraji', Sunni fatwa institutions, the Vatican/USCCB, the World Medical Association, WHO, and NICE. Search concepts combined suicide/self-harm, intentional self-poisoning/poisoning, medical ethics, treatment refusal, decision-making capacity, confidentiality, spiritual care, Islamic ethics, Shi'a jurisprudence, Sunni jurisprudence, euthanasia, and physician-assisted suicide. Sources were screened for relevance, traceability, authority, and direct applicability to the review question.
Results: The evidence supports a consistent clinical principle across contemporary guidance: patients who self-poison should receive appropriate medical treatment, privacy, non-punitive care, and timely psychosocial assessment. Religious sources examined here generally prohibit intentional self-killing, but they differ in terminology, jurisprudential reasoning, and treatment of responsibility, especially where severe psychological disturbance may affect responsibility. Contemporary bioethics distinguishes suicide attempts from capacitated treatment refusal and from euthanasia or physician-assisted suicide. These distinctions are essential in poisoning emergencies.
Conclusion: Religious and ethical perspectives should inform, but not replace, evidence-based toxicological and psychosocial care. An interdisciplinary, patient-centered continuum from acute poisoning treatment through structured follow-up may support the prevention of recurrent intentional self-poisoning.
- Suicide, Self-harm, Intentional self-poisoning, Poisoning, Clinical toxicology, Medical ethics, Decision-making capacity, Treatment refusal, Islamic bioethics, Spiritual care
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References
[1] Santana Carmen. mhGAP Intervention guide for mental, neurological and substance use disorders in non-specialized health settings: version 2.0. Jornal Brasileiro de Psiquiatria. 2018. [DOI:10.1590/0047-2085000000206]
[2] Self-harm: assessment, management and preventing recurrence. London: National Institute for Health and Care Excellence (NICE); 2022 Sep 7. (NICE Guideline, No. 225.) [Link]
[3] Inbadas H, Zaman S, Whitelaw S, Clark D. Declarations on euthanasia and assisted dying. Death Stud. 2017;41(9):574-84. [DOI: 10.1080/07481187.2017.1317300]
[4] WMA Declaration of Venice on Terminal Illness WMA General Assembly, Pilanesberg, South Africa, October 2006, Handbook of WMA Policies D-1983-01-2006. [Link]
[5] Internet Office of the Holy See [Internet]. [cited 2026 Oct 3]. Catechism of the catholic church. [Link]
[6] Diometuchen.org [Internet]. [cited 2026 Oct 3]. [Link]
[7] Sistani.org [Internet]. [cited 2026 Oct 3]. Topics - question & answer - the official website of the office of his eminence Al-Sayyid Ali Al-Husseini Al-sistani. [Link]
[8] Sistani.org [Internet]. [cited 2026 Oct 3]. CHAPTER THIRTY-SEVEN» Will (Waṣiyyah) - Islamic Laws - the official website of the office of his eminence Al-Sayyid Ali Al-Husseini Al-sistani. [Link]
[9] Dar-alifta.org [Internet]. [cited 2026 Oct 3]. [Link]
[10] Aliftaa.jo [Internet]. [cited 2026 Oct 3]. Suicide is a Major Sin. [Link]
[11] Iserson KV. Principles of biomedical ethics. Emerg Med Clin North Am. 1999 May;17(2):283-306, ix. [DOI: 10.1016/s0733-8627(05)70060-2]
[12] Kuhse H, Singer P, editors. A Companion to Bioethics. Malden, MA: Blackwell; 2001. [Link]
[13] Shirzad J, Gharedaghi J. Study of methods and causes of suicides resulting in death referred to the Legal Medicine Organization of Iran in the first six months of 2004. Iranian Journal of Forensic Medicine. 2007;13(3):163–70. [Persian]
[14] Ghoreishi SA, Mousavinasab N. Systematic Review of Research on Suicide and Suicide Attempt in Iran. Iranian Journal of Psychiatry and Clinical Psychology. 2008;14(2):115–21. [Link]
[15] Hosseini E. The Principles and Standards of Medical Ethics and Their Compatibility with the Fundamentals of Islamic Ethics. Studies in Medical Sciences. 2008;18(4):652–6. [Link]
[16] Bidel Z, Nazarzadeh M, Ayobi E, SayehMiri K. Prevalence of important poisoning methods used in Iranian suicides: a systematic review and meta-analysis. Koomesh. 2013;14(3):257–64. [DOI: 10.22110/koomesh.2013.152574]
[17] Madani M, Madani E. Ethical and practical considerations on refusal of medical treatment. Journal of Medical Ethics & History of Medicine. 2014;7(4). [Link]
[18] Mohammadi M, Dayyani Tilaki MS, Larijani B, et al. Patients’ attitudes about privacy and confidentiality in selected hospitals in Tehran. Iranian Journal of Medical Ethics and History of Medicine. 2017;9(6):5–19. [Link]
[19] Yavari N, Parsapoor A. The domain of autonomy, limitations, and solutions. Iranian Journal of Medical Ethics and History of Medicine. 2017;10:182–197. [Link]
[20] Rahaie S, Heidari F. Right to Choose between Life-Sustaining Treatments and Palliative Care in the Shi’ite Jurisprudential Perspective. Iranian Journal of Medical Ethics and History of Medicine. 2017;10:198–210. [Link]
[21] Delirrad M, Alizadeh A, Majidi M, Balali-Mood M. Status of clinical toxicology education and ethics in medical care of poisoned patients in the Islamic Republic of Iran and a comparison with other countries. Basic Clin Pharmacol Toxicol. 2020;126(Suppl 1). [DOI: 10.1111/bcpt.13380]
[22] Moukarzel A, Michelet P, Durand AC, et al. Burnout syndrome among emergency department staff: prevalence and associated factors. Biomed Res Int. 2019;2019:6462472. [DOI: 10.1155/2019/6462472]
[23] Zhang Q, Mu MC, He Y, Cai ZL, Li ZC. Burnout in emergency medicine physicians: a meta-analysis and systematic review. Medicine (Baltimore). 2020;99(32):e21462. [DOI: 10.1097/MD.0000000000021462]
[24] Zarani F, Ahmadi Z. Suicide in Iranian culture: A systematic review study. Rooyesh-e-Ravanshenasi Journal. 2021;10(9):205–16. [Link]
[25] Phillips K, Knowlton M, Riseden J. Emergency Department Nursing Burnout and Resilience. Adv Emerg Nurs J. 2022;44(1):54–62. [DOI: 10.1097/TME.0000000000000391]
[26] Kasmaei M, Bakerdar H, Asadi F. Comparative Study of Occupational Burnout between Professors and Residents of Emergency Medicine in Educational-Remedial Centers of Medical Sciences Universities. Research in Medical Education. 2022;14(1):54–63. [Link]
[27] Baker JC, Starkey A, Ammendola E, et al. Telehealth Brief Cognitive Behavioral Therapy for Suicide Prevention: A Randomized Clinical Trial. JAMA Netw Open. 2024;7(11):e2445913. [DOI: 10.1001/jamanetworkopen.2024.45913]
[28] Sharma V, Marshall D, Fortune S, et al. Prevention of self-harm and suicide in young people up to the age of 25 in education settings. Cochrane Database Syst Rev. 2024;12(12):CD013844. [DOI: 10.1002/14651858.CD013844.pub2]
[29] Ahmadi M, Arsalani N, Moghadam F, Naseh L, Taghlili F, Fallahi-Khoshknab M. Burnout in emergency nurses: A systematic review. Iranian Journal of Systematic Review in Medical Sciences. 2024;2(1):56–68. [Link]
[30] Royal College of Emergency Medicine & National Poisons Information Service. Management of patients with suspected but unidentified poisoning in the emergency department: joint best practice guideline. Emerg Med J. 2026. [DOI: 10.1136/emermed-2025-215194]
[31] My Jewish Learning. Judaism and Suicide. Contemporary Jewish perspectives on suicide, preservation of life, and the role of mental illness in responsibility. Accessed September 2026. [Link]
[32] Lopatin A. Pikuach Nefesh: The Jewish Value of Saving a Life. My Jewish Learning. Discussion of preservation of human life as a central principle of Jewish law. Accessed September 2026. [Link]
[33] Nahj al-Balagha. Sermon 198. In: Nahjul Balagha Part 1, The Sermons. Al-Islam.org. [Link]
[34] Nahj al-Balagha. Sermon 176. In: Nahjul Balagha Part 1, The Sermons. Al-Islam.org. [Link]
[35] Islamic Republic of Iran. Civil Code, Articles 958–60. [Link]
[36] Ministry of Health and Medical Education, Islamic Republic of Iran. Patient Rights Charter. [Link]
[37] Bucar EM. Islamic Virtue Ethics. In: Snow NE, ed. The Oxford Handbook of Virtue. Oxford University Press; 2017:206–23. [DOI: 10.1093/oxfordhb/9780199385195.013.9]
[38] Encyclopedia Iranica. Meskawayh, Abu Ali Ahmad. Accessed September 2026. [Link]
[39] Griffel F. Al-Ghazali. Stanford Encyclopedia of Philosophy. Accessed September 2026.
[40] Chittick WC. Rumi, Jalāl-al-Din vii. Philosophy. Encyclopedia Iranica. Updated August 14, 2017. [Link]
[41] Mojaddedi J. Rumi, Jalāl-al-Din viii. Rumi’s Teachings. Encyclopedia Iranica. Updated August 14, 2017. [Link]
[42] Sarwer MA, Zafar A. Sheikh Saadi’s Theory of Morality in the Light of Gulistan-e-Saadi. Al-Bahis Journal of Islamic Sciences Research. 2021;2(2). [DOI: 10.66212/brjisr.v2i2.76]
[43] Johnson R, Cureton A. Kant’s Moral Philosophy. Stanford Encyclopedia of Philosophy. Accessed September 2026. [Link]
[44] Cholbi M, et al. Suicide. Stanford Encyclopedia of Philosophy. Spring 2026 edition. [Link]
[45] Fasih A. Enduring Oaths. AMA Journal of Ethics. 2019;21(3):E300–302. [DOI: 10.1001/amajethics.2019.300]
[46] World Health Organization. Suicide: Questions and answers. 31 August 2026. [Link]
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