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The 'rational suicide' dilemma.

The 'rational suicide' dilemma

A homosexual man with AIDS is admitted to a hospital because of his rapidly deteriorating physical condition. Four weeks later, he is found comatose in his bed with an empty vial of an unprescribed medicine on his night table. His physicians do not attempt to resuscitate him and he dies within the hour.

Another man, a widower in his 80s, is found unconscious by his children following a suspected drug overdose. In a suicide note, he says he has led a full life and wants to avoid the infirmities of old age. He previously drafted a "living will" asking not to be kept alive by "heroic measures" should he become seriously ill. But at a nearby emergency room, physicians disregard his wishes and save his life.

These cases, described in the November GENERAL HOSPITAL PSYCHIATRY, illustrate a wrenching ethical conflict physicians increasingly face. On one hand, a person making a serious suicide attempt is considered mentally ill and in need of psychiatric help. Yet courts and physicians now routinely grant people the right to refuse medical treatment if those patients feel the benefits do not justify the pain or emotional turmoil associated with such interventions. Which principle is followed by physicians when patients who have attempted suicide refuse medical treatment because they want to die?

It remains unclear whether withholding medical treatment following a suicide attempt amounts to aiding suicide and to what extent such a decision can be justified by the presence of a terminal illness, say psychiatrist Harry Karlinsky and his colleagues at Toronto General Hospital. But suicide attempts by hospitalized patients with "do not resuscitate" orders on their medical charts should be met by active resuscitation efforts unless recovery is unlikely, they suggest. If resuscitation is successful, patients deemed mentally competent could then reject further lifesaving treatment. This approach is supported by evidence that only a small number of individuals who survive a suicide attempt later commit suicide.

In an accompanying comment, psychiatrist Paul S. Appelbaum of the University of Massachusetts Medical School in Worcester says some suicide decisions may be rational and psychiatrists will probably need to develop guidelines for assessing "competence to commit suicide."
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Publication:Science News
Date:Dec 3, 1988
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