Citation

Bostwick JM, Cohen LM. Psychosomatics 2009; 50(1): 1-7.

Affiliation

Mayo Clinic, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. bostwick.john@mayo.edu

Copyright

(Copyright © 2009, Academy of Psychosomatic Medicine, Publisher Elsevier Publishing)

DOI

10.1176/appi.psy.50.1.1

PMID

19213966

Abstract

BACKGROUND: Technological advances continue to yield life-prolonging treatments that complicate the occurrence of death. Until recently, refusal to submit to recommended care was considered suicide. OBJECTIVE: Physicians must now decide how to respond to requests for hastened dying. METHOD: The authors propose a four-square grid distinguishing true suicide from behaviors such as treatment termination and lethal noncompliance. RESULTS: One axis characterizes whether actions hasten death. The other identifies how the patient's social and medical network collaborate in the decision-making process. CONCLUSION: Using chronic kidney disease to model intent and collaboration, treatment is framed within a paradigm that reflects both end-of-life decision-making complexities and contemporary conceptualizations of suicide.

Language: en