John Michael Bostwick1, Lewis M Cohen. 1. Mayo Clinic, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. bostwick.john@mayo.edu
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.
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.
Authors: Gabrielle Macaron; Mario Fahed; Dany Matar; Rami Bou-Khalil; Francois Kazour; Dania Nehme-Chlela; Sami Richa Journal: Community Ment Health J Date: 2013-12-13