ETHICAL AND COMPETENT CARE OF SUICIDAL PATIENTS

Ethical and Competent Care of Suicidal Patients

Ethical and Competent Care of Suicidal Patients

Introduction

The suicide of a patient is one of the most stressful adversities in training. According to Sudak Roy Sudak et al (2007), and in light of the limitations of the data, there are a range of possible distressing psychological consequences following the suicide of a patient. Most residents experience an initial shock and disbelief, which in some cases can last up to 1 month or longer. This initial response can be accompanied by depressive ruminations when residents search for the "fatal mistake," and by anger, shame, and guilt(Oliva 2001). Physical health, personal and professional relationships, and professional ambitions might also be affected, although the impact on residents' emotional health exceeds that on all other domains. Other possible responses include alienation, loss of confidence, and recurrent feelings of horror. In addition, longer term distressing psychological consequences similar to posttraumatic stress are possible.

Discussion

The conduct of clinicians is guided by ethics codes that provide nominal protection to suicidal clients. The codes draw on these principles(Hamaoka Fullerton Benedek 2007):

Autonomy - Respect for the individual self-determination

Beneficence - Doing the greatest good possible

Non-maleficence - Minimizing or preventing harm

Justice - Fairness and equal access to care.

Bioethics has developed responsibilities based on autonomy:

Respect for person - The basis of client rights

Telling the truth and giving all the facts - Disclosure

Confidentiality - Maintaining client privacy

Fidelity - Doing the job" and "being there" for the client.

Beneficence is acting in the best interest of clients. Non-maleficence is minimizing harm. Justice is treating individuals fairly.

Autonomy and Suicide

This principle impacts the clinical response to all suicidal individuals. It calls for respect, dignity, and choice. The last often takes precedence(Sudak Roy Sudak et al 2007).

Respect for personal rights: This duty sanctifies choice. Suicide is the outcome of psychological debilitation. Extending autonomy to those so afflicted facilitates suicide. Respect for the individual is better served by recognizing their vulnerability.

Telling the truth: Clients at risk deserve candor as to their exposure and means of intervention. Clinicians with strong views about suicide should disclose them or refer the client elsewhere.

Confidentiality: This presents many dilemmas. Suicidality and secrecy are a fatal combination. In some states clinicians may breach confidentiality if the client is a danger to themselves or others. Therapists must disclose if the client is a threat to others. Disclosure of suicidality not mandated.

Fidelity: Clinicians are to be faithful to clients. The risk of suicide must be taken seriously and be acknowledged as the primary problem. Fidelity also demands that clinicians update their views and skills. Outmoded views of suicide put clients at risk.

Prevention at an individual level, or the provision of care commensurate with standards of excellence for identifying and managing potentially suicidal patients, is a central ethical concern. Prevention includes treatment of the underlying mental disorder and intervention to protect against suicide when suicide is judged to be imminent(McCullough Coverdale ...