Ethical challenges in clinical care of suicidal patients

Abstract

Suicide management is attended with ethical dilemmas. Philosophical positions like respect for life (which generally accords with the theological position), autonomy, duty to others, and utilitarianism; as well as legal requirements provide a context for ethical decision making. Ethical principles involved are duty to others, autonomy (including informed consent and confidentiality), beneficence and non-maleficence. The application of these principles are considered in various clinical situations related to acute care (advanced directives, withdrawal of or withholding life-sustaining treatments, surrogate decision makers, informed consent, no-suicide contracts, involuntary hospitalization) as well as long-term care in mental health settings (acutely and chronically suicidal patients, patients with suicidal behavior who are not in a suicidal crisis, and therapeutic relationship). Organizational issues (legal statutes, institutional preparedness) and cultural issues (family ties, religiosity) relevant to ethics related to suicidality are also discussed. It is emphasized that professional bodies should appreciate the difficulties faced by health-care professionals in the ethical decision making related to suicide and develop instruments to support them.