Fine M A, Sansone R A
Department of Psychology, University of Dayton, OH 45469-0001.
Am J Psychother. 1990 Apr;44(2):160-71. doi: 10.1176/appi.psychotherapy.1990.44.2.160.
Managing suicidal behavior of individuals with borderline personality disorder presents both therapeutic and ethical/legal dilemmas. It is argued in this paper that clinicians treating borderline individuals need to carefully discriminate "acute" from "chronic" suicidal states. For "acute" suicidal situations, traditional management approaches are appropriate. However, for "chronic" situations, common among borderline individuals, traditional management approaches may be therapeutically counterproductive. A number of proposals for managing chronic suicidal behavior are reviewed. Unfortunately, current ethical standards and laws have evolved from considering suicide in an "acute" context and are insensitive to the "chronic" situation. Recommendations are made for clinicians to effectively manage chronic suicidal behaviors within present ethical and legal guidelines, and some suggestions for legal reform are offered.
处理边缘型人格障碍患者的自杀行为会带来治疗和伦理/法律困境。本文认为，治疗边缘型人格障碍患者的临床医生需要仔细区分“急性”和“慢性”自杀状态。对于“急性”自杀情况，传统的处理方法是合适的。然而，对于边缘型人格障碍患者中常见的“慢性”情况，传统的处理方法可能在治疗上适得其反。本文回顾了一些处理慢性自杀行为的建议。不幸的是，当前的伦理标准和法律是在“急性”背景下考虑自杀问题而发展起来的，对“慢性”情况不敏感。本文为临床医生在当前伦理和法律准则内有效处理慢性自杀行为提出了建议，并提供了一些法律改革建议。
