If a perfectly competent patient who has been depressed for most of his 55 years describes a plan to kill himself next week…what is the role of his doctor?
If a perfectly competent patient who has been depressed for most of his 55 years describes a plan to kill himself next week…what is the role of his doctor?
secretwave101 
I’m inclined to think that if he told you, it’s a cry for help. The ones that I know of that really meant it (and carried it out) never let on a thing beforehand.
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Would typically agree except this pt. was presented as being flatly rational and expressing unhappiness that his terminal illness appeared to be in remission. Brought up autonomy questions for me.
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Hmmm. Despite the risk of waxing philosophical wanly, I would then say this:
Don’t mistake “flatly rational” for real rationality. Just because the person is not talking jibberish, or with nonsensical ideas, does NOT mean they are necessarily rational.
Is it rational to see only one solution to a problem? And a solution that outstrips the problem in depth, breadth, longevity, and gravity? Have other possibilities at least been objectively considered?
A second clue is the unhappiness at the remission. Terminal illnesses bring about a myriad of emotions, some unexperienced until that time, all of them affecting the mental state whether consciously or unconsciously. And now the disease took another direction? More emotions! Different types! More decision making! More preparation! Yoy!
You don’t say how long this has been “developing” in the man, but I would guess that it is insufficient for him to 1) resolve the rational outlook question and 2) definitely not resolve the emotional question.
Is a patient autonomous to kill themselves? Well, that’s the paradox: slowly? Sure, by smoking, drug abuse etc. Quickly? Nope, at least not in 49 states anyway. :p
Is the patient autonomous to discontinue noxious treatment? Futile treatment? Treatment that conflicts with their personal values? I think most people would say sure.
What is the true intent of the patient? To die, period, or to simply remove a threat to his wellbeing, be it emotional, mental, spiritual, even if not physical? I would at least try to see what the threat was and to help him resolve it.
If he wants to die, he will. If he is experiencing a threat, I would expect that he would appreciate direction in its resolution.
I’ll stop now… š
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