Karlinsky H, Taerk G, Schwartz K, Ennis J, Rodin G
Department of Psychiatry, Toronto General Hospital, University of Toronto, Ontario, Canada.
Gen Hosp Psychiatry. 1988 Nov;10(6):423-30. doi: 10.1016/0163-8343(88)90065-5.
The conventional psychiatric opinion that suicide is a manifestation of psychiatric illness may not apply to circumstances in which suicide or the refusal of life-sustaining medical treatment results from the rational decisions of autonomous individuals. As medical technology advances, questions about the prolongation of life and the discontinuation of medical treatment have become commonplace in the medical setting. In this context, contradictions may exist between the principle of patient autonomy and that of physician responsibility. Dilemmas about treatment decisions that emerge from these conflicting perspectives are highlighted in this article. We report two cases of attempted suicide in the context, respectively, of (1) terminal illness and (2) advanced age. Some of the complex psychiatric, ethical, and legal issues related to the case reports are addressed.
传统的精神病学观点认为自杀是精神疾病的一种表现，但这可能不适用于自杀或拒绝维持生命的医疗治疗是自主个体理性决定的情况。随着医疗技术的进步，关于延长生命和停止医疗治疗的问题在医疗环境中已变得司空见惯。在此背景下，患者自主权原则与医生责任原则之间可能存在矛盾。本文强调了由这些相互冲突的观点引发的治疗决策困境。我们报告了两例自杀未遂案例，分别发生在（1）晚期疾病和（2）高龄的背景下。文中还讨论了与病例报告相关的一些复杂的精神病学、伦理和法律问题。
