Why are people with mental illness excluded from the rational suicide debate?
Why are people with mental illness excluded from the rational suicide debate?
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DOI：
10.1016/j.ijlp.2013.06.006
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发表时间：
2013-09-01
影响因子：
2.3
通讯作者：
Hewitt, Jeanette
中科院分区：
文献类型：
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作者：
Hewitt, Jeanette
理性自杀的话题经常被心理健康专业人士带着一些恐惧对待。自杀预防策略更可能被视为精神病学的领域，大量的精神病学文献致力于识别和管理自杀风险。自杀是否可以被认为是允许的，表面上与自主权和精神能力的讨论有关，英国立法规定，在决定能力完好的情况下，在拒绝治疗方面必须尊重病人的意愿。在护理和治疗身体疾病患者的背景下，极端和无法治疗的身体痛苦可能会被接受为自杀的合理理由，如果这个人拥有认知连贯性和现实地理解其行为后果的能力。至于严重精神病患者，接受自杀是合理行为的理据则不太明确。严重精神病通常被认为是一种胁迫性的压力，阻止理性的考虑，因此，严重精神病患者的自杀被认为是基本上非自愿的行为，源于构成性的非理性。因此，当一个适当的临床医生判断一个患有严重精神障碍的人是非自主的，自杀预防可能会被认为在法律上和道德上是合理的。精神病学所采取的立场有两个有争议的假设：首先，心因性疼痛在某种程度上比身体疼痛少真实的，其次，精神疾病总是意味着死亡的愿望是不合理的和不真实的。如果可以证明，一些患有严重精神疾病的人在自杀方面是理性的，而且心理痛苦与身体痛苦具有同等重要性，那么就有可能得出结论，根据定义，一些患有严重精神疾病的人不应该被排除在理性自杀可能是一种连贯选择的人之外。(C)2013爱思唯尔有限公司保留所有权利。
The topic of rational suicide is often approached with some trepidation by mental health professionals. Suicide prevention strategies are more likely to be seen as the domain of psychiatry and a wealth of psychiatric literature is devoted to identifying and managing suicide risk. Whether or not suicide can be deemed permissible is ostensibly linked to discussions of autonomy and mental capacity, and UK legislation directs that a patient's wishes must be respected with regard to treatment refusal where decisional capacity is intact. In the context of the care and treatment of those with physical disorders, extreme and untreatable physical suffering is likely to be accepted as rational grounds for suicide, where the person possesses cognitive coherence and an ability to realistically appreciate the consequences of his or her actions. In the case of those with serious mental disorder, the grounds for accepting that suicide is rational are however less clear-cut. Serious mental illness is typically conceived of as a coercive pressure which prevents rational deliberation and as such, the suicides of those with serious mental illness are considered to be substantially non-voluntary acts arising from constitutive irrationality. Therefore, where an appropriate clinician judges that a person with serious mental disorder is non-autonomous, suicide prevention is likely to be thought legally and morally justified.There are arguably, two questionable assumptions in the position that psychiatry adopts: Firstly, that psychogenic pain is in some way less real than physical pain and secondly, that mental illness invariably means that a desire to die is irrational and inauthentic. If it can be shown that some people with serious mental illness can be rational with regard to suicide and that psychological pain is of equal significance as physical suffering, then it may be possible to conclude that some persons with serious mental illness should not by definition be excluded from the class of those for whom rational suicide may be a coherent choice. (C) 2013 Elsevier Ltd. All rights reserved.