Saigle Victoria, Racine Eric
Neuroethics Research Unit, Institut de recherches cliniques de Montréal, 110 avenue des Pins Ouest, Montreal, QC, H2W lR7, Canada.
Biomedical Ethics Unit, Department of Experimental Medicine, McGill University, Montreal, QC, Canada.
Monash Bioeth Rev. 2018 Jul;35(1-4):50-79. doi: 10.1007/s40592-018-0076-z.
For each one of the approximately 800,000 people who die from suicide every year, an additional twenty people attempt suicide. Many of these attempts result in hospitalization or in contact with other healthcare services. However, many personal, educational, and institutional barriers make it difficult for healthcare professionals to care for suicidal individuals. We reviewed literature that discusses suicidal patients in healthcare settings in order to highlight common ethical issues and to identify knowledge gaps. A sample was generated via PubMed using keywords "[(ethics OR ethic) AND suicid*] AND [English (Language) OR French (Language)]" (final N = 52), ethics content was extracted according to scoping review methodology, and categorized thematically. We identified three main areas posing ethical challenges for health professionals caring for suicidal individuals and their families. These were: (1) making clinical decisions for patients in acute care or when presented with specific circumstances; (2) issues arising from therapeutic relationships in chronic care, and (3) organizational factors. There is considerable uncertainty about how to resolve ethical issues when caring for someone who is suicidal. The stigma associated with suicide and mental illness, problems associated with risk-benefit assessments, and the fear of being held liable for malpractice should a patient die by suicide were overarching themes present across these three categories. Caring for suicidal patients is clinically and ethically challenging. The current literature highlights the complexity and range of decisions that need to be made. More attention should be paid to the difficulties faced by healthcare professionals and the development of solutions.
每年约有80万人死于自杀，而每有一人自杀死亡，就另有20人试图自杀。这些自杀未遂事件中有许多导致患者住院或接受其他医疗服务。然而，诸多个人、教育及制度上的障碍使得医护人员难以照护有自杀倾向的个体。我们查阅了讨论医疗环境中自杀患者的文献，以突出常见的伦理问题并找出知识空白。通过在PubMed上使用关键词“[(伦理或ethic)与自杀*]与[英语（语言）或法语（语言）]”生成样本（最终数量N = 52），按照范围综述方法提取伦理内容并进行主题分类。我们确定了三个主要领域，它们给照护自杀患者及其家属的医护人员带来了伦理挑战。这些领域是：(1) 在急性护理中或面对特定情况时为患者做出临床决策；(2) 长期护理中治疗关系引发的问题，以及(3) 组织因素。在照护有自杀倾向的人时，对于如何解决伦理问题存在相当大的不确定性。与自杀和精神疾病相关的污名、与风险效益评估相关的问题，以及如果患者自杀死亡担心被追究医疗事故责任，是这三个类别中普遍存在的首要主题。照护自杀患者在临床和伦理方面都具有挑战性。当前的文献突出了需要做出的决策的复杂性和范围。应更多关注医护人员面临的困难以及解决方案的制定。
