We welcome the insightful comments from Dieneke Hubbeling (Hubbeling, Reference Hubbeling2014) and the opportunity to clarify the primary objective of our editorial (Dazzi et al. Reference Dazzi, Gribble, Wessely and Fear2014).
While we agree that the evidence the editorial was based on is limited somewhat by the outcome that the studies were measuring, we feel it is important that the decisions ethics committee reach are evidence based. If the available evidence does not support an association between asking questions about suicide and suicidality, then any limitations placed on a proposed research project should be justified, particularly as the general direction of travel seems to be that asking questions is more likely to reduce suicidality than increase it (see for example: Cedereke et al. Reference Cedereke, Monti and Ojehagen2002; Vaiva et al. Reference Vaiva, Ducrocq, Meyer, Mathieu, Philippe, Libersa and Goudemand2006; Biddle et al. Reference Biddle, Cooper, Owen-Smith, Klineberg, Bennewith, Hawton, Kapur, Donovan and Gunnel2013). We are not saying that such a situation can never be found, but that a good case needs to be made if restrictions are put in place.
We respectfully disagree with the comment that the scientific benefits of such research are limited if only suicidal ideation, rather than completed or attempted suicide is studied. First, such a step would miss the opportunity for early intervention among those expressing suicidal intent. Second, preventing researchers from asking about suicidal intent among those who have attempted suicide, for example, would do little to advance much-needed research in this area. Finally, suicide is fortunately a rare outcome, and notoriously difficult to predict by even the most experienced clinician. We suspect that obtaining definitive data on that particular question will always prove problematical.