There is a difference between wanting to die and not wanting to stay alive. For patients with terminal physical illnesses who are suffering, there is an acceptance that they do not specifically want to die, rather that living is no longer tolerable for them.

We can’t conduct randomized trials to evaluate whether patients, would choose death over than life.

For other groups in our society, suicide it is not about mental or physical illness in an individual. There is an alternate reality. Suicide can be the desirable endpoint for a collective not individual woe, as is the case of the self immolators and hunger strikers. The evolved species of suicide bombers, for example, are more akin to a sophisticated “piece” of technological weaponry than a person with an illness or grievance.

Suicide bombers are often young. In younger people, the difference between choosing to die and not wanting to stay alive is not always clear. Whilst up to 24% of adolescents, think about suicide, less 0.024% actually die from their own volition – a thousand times less.

Why is there such a difference? Part of the problem is that “wanting to die” is placed at one end of a spectrum and “wanting to live” at the other. It is a logic mismatch because the two concepts are not part of the same continuum.  It may be that not wanting to live is the much stronger driver for some of them.

We may never be able to substantiate these assertions. There can be no randomized trials on evaluating whether patients, would choose death over than life. We know from patients with terminal illnesses that they don’t want to live and when we talk with people who have attempted suicide about their wish to die or wish to live, less than half could choose between the two.

It is a complex picture that cannot be resolved simply by interventions such as suicide prevention programmes. To improve our understanding of suicidal thoughts and actions, we need to start asking congruent questions and interpreting meaningful answers. Wanting to die is not the same as not wanting to stay alive.