What do we mean when we say it today?
Most of us aren't contemplating suicide when we say this phrase today. But the phrase "that it should come to this" is still usually said out of frustration or annoyance. It's maddening that things turned out this way. I can't believe it. Grrr… Etc.
Sometimes people are at an impasse when they say this. They just can't see how to solve the friendship/business deal/romance. But usually it has nothing to do with life or death. Sure, business decisions and romances are important, but they're not quite so drastic, now are they?
And we're pretty grateful for that. We'd rather not be saying this phrase in the way that Hamlet is.