[What can psychiatrists do for patients who want to die?].

The desire to commit suicide frequently arises in mentally ill patients, but how to present a persuasive argument to dissuade these patients from committing suicide remains a difficult challenge. This issue is considered below, while referring to the highly publicized Chabot case, in which a psychiatrist assisted in the suicide of a patient who was depressed by the loss of two sons under unfortunate circumstances. Euthanasia, or assisted suicide, has generally been criticized for the following reasons: 1) It is impossible to ascertain whether the free will of the patient, considered to be the fundamental basis for self-determination, was intact at the time of performing the procedure. 2) If the practice becomes widespread, then there exists the potential for vulnerable patients to receive perfunctory medical care; 3) Frequently, the desire to die is transient and ambivalent; 4) The ramifications associated with death extend beyond the individual and may be particularly acute with the family. Each of these arguments can be used as a logical counterargument to suicide, and, to the extent that they are based on the fact that death is irreversible, they are effective. However, although we are generally opposed to euthanasia and assisted suicide, we believe that these arguments are ill-suited for convincing individual patients not to commit suicide. An overview of discussions of the Chabot case is considered useful for reflecting on ways to prevent suicide, including psychotherapeutic relationships. The issue of how to respond to patients at a high risk of suicide in Japan is also considered based on these discussions. Lacking sufficient criteria for determining the competence of a patient who wants to die, the position that medical treatment can be provided simultaneously while assessing the competence of the patient is considered meaningless. In addition, there is a danger that strongly promoting the treatment of depression in patients at high risk for suicide denies the patient his or her free will by inviting excessive medicalization and encroaching on the patient's "freedom to die." We believe that the only course one can take is to get close to the patient's pain and anguish, while directly confronting the dilemma of the patient's right to die versus assisting the patient to live.