Kelly B J, Varghese F T
Department of Psychiatry, University of Queensland, Princess Alexandra Hospital, Brisbane.
Aust N Z J Psychiatry. 1996 Feb;30(1):3-8. doi: 10.3109/00048679609076068.
This paper aims to address the clinical issues involved in a patient's request for assisted suicide. The psychiatric and broader psychosocial issues for the dying patient, their family and their treating doctor have been largely unaddressed in the debate concerning euthanasia to date. A range of the clinical issues that need to be incorporated in the ethical and legal considerations are reviewed. The reasons for a patient seeking suicide as a treatment are complex and go beyond questions of a patient's right to die. The request for euthanasia needs to be seen in the context of the patient's circumstances, including relationships with and attitudes of carers and health professionals, along with patterns of psychiatric disorder and psychiatric symptoms in the medically ill. The clinical issues involve not only the diagnosis or management of psychiatric disorder but also the acknowledgment of the factors influencing an individual's adjustment to the threat of illness and death. The dynamics of family interactions and doctor-patient relationships in this setting are factors that may impinge upon a request for assistance to die. These factors may be more important than the severity of a person's illness or their quality of life, and are less likely to be recognised and addressed in situations of professional isolation. There are critical issues facing psychiatry in new legislative developments.
本文旨在探讨患者请求协助自杀所涉及的临床问题。迄今为止，在关于安乐死的辩论中，临终患者及其家人以及主治医生所面临的精神科及更广泛的社会心理问题在很大程度上未得到探讨。本文回顾了一系列需要纳入伦理和法律考量的临床问题。患者寻求自杀作为一种治疗方式的原因很复杂，且超出了患者死亡权利的问题范畴。安乐死请求需要结合患者的具体情况来看待，包括与护理人员及医疗专业人员的关系和态度，以及身患疾病者的精神障碍模式和精神症状。临床问题不仅涉及精神障碍的诊断或管理，还包括对影响个体适应疾病和死亡威胁的因素的认识。在这种情况下，家庭互动和医患关系的动态变化是可能影响安乐死请求的因素。这些因素可能比一个人的疾病严重程度或生活质量更重要，而且在专业孤立的情况下不太可能得到认识和解决。在新的立法发展中，精神病学面临着关键问题。
