Santander Jaime, Brokering Walter, Ramos Paulina, Arenas Ángela
Rev Med Chil. 2015 Apr;143(4):506-11. doi: 10.4067/S0034-98872015000400013.
Suicide is a complex phenomenon that has accompanied human beings throughout history. Its strong association with mental disorders led to its medicalization and psychiatrists became the physicians in charge of diagnosing and treating patients at risk of suicide. This article discusses the potential limitations that psychiatrists may face when diagnosing suicide risk and providing optimal care. Evidence of the eventual inevitability of suicide and the tension that may arise between providing optimal treatments on the one hand and preserving the rights of patient's autonomy and dignity on the other is also presented. We propose that although diagnosing and adequately treating patients at risk of suicide would be the psychiatrist's responsibility, the act of suicide itself is personal and non-transferable. Considering the latter as part of the medical team's responsibilities would turn working with patients with mental disorders into a fearless act. Finally, suicide should be considered to be part of the natural history of the evolution of many mental disorders and, thus, should constitute a specific topic when training specialists.
自杀是一种复杂的现象,自古以来一直伴随着人类。它与精神障碍的密切关联导致了其医学化,精神科医生成为负责诊断和治疗有自杀风险患者的医生。本文讨论了精神科医生在诊断自杀风险和提供最佳护理时可能面临的潜在局限性。还介绍了自杀最终不可避免的证据,以及一方面提供最佳治疗与另一方面维护患者自主权和尊严权利之间可能产生的紧张关系。我们建议,虽然诊断和充分治疗有自杀风险的患者是精神科医生的责任,但自杀行为本身是个人的且不可转移。将后者视为医疗团队责任的一部分会使与精神障碍患者合作变成一种无畏的行为。最后,自杀应被视为许多精神障碍演变自然史的一部分,因此,在培训专科医生时应构成一个特定主题。