Clinical Education, Development and Research (CEDAR), Department of Psychology, University of Exeter, Exeter, UK.
Faculty of Social Sciences, University of Kassel, Kassel, Germany.
Int J Psychoanal. 2022 Feb;103(1):71-88. doi: 10.1080/00207578.2021.1999773.
The legalisation of assisted dying, including euthanasia and physician assisted suicide, is increasing in countries across the world and constitutes a key contemporary debate, reflecting social changes, in which two views of suicide conflict; that (1) rational reasons justify assisted suicide, providing dignity and control of terminal illness and (2) suicidal wishes are driven by unconscious and disturbing internal conflicts. In this paper we explore the unconscious motives and meanings of requests for assisted suicide. Although there is a paucity of psychoanalytic literature on the subject, and an absence of practice examples, we make two links, firstly, with the literature of palliative and end of life care, and, secondly, with psychoanalytic understanding of suicide, in order to develop the view that unconscious factors are crucial to understanding requests for assisted suicide. We provide an illustrative case example of psychodynamic psychotherapy with a 94-year-old woman, drawing out theoretical and practice implications. We show that unconscious factors and motives lie behind apparently rational requests for assisted suicide, and attention to these through psychoanalytically informed treatment can bring about therapeutic change.
协助自杀（包括安乐死和医师协助自杀）的合法化在全球各国日益增多，这构成了当代的一个重要辩论，反映了社会变革，其中自杀的两种观点相互冲突：（1）理性理由证明协助自杀合理，为末期疾病提供尊严和控制；（2）自杀的愿望是由无意识和令人不安的内在冲突驱动的。在本文中，我们探讨了协助自杀请求的无意识动机和意义。尽管关于这个主题的精神分析文献很少，也没有实践案例，但我们做了两个联系，首先是与姑息治疗和生命末期护理的文献联系，其次是与对自杀的精神分析理解联系，以便发展这样一种观点，即无意识因素对于理解协助自杀请求至关重要。我们提供了一个 94 岁女性的精神动力学心理治疗的案例说明，引出了理论和实践的影响。我们表明，无意识因素和动机是表面上合理的协助自杀请求背后的原因，通过精神分析知情的治疗来关注这些因素可以带来治疗上的变化。
