["Wish to die" and "right to die" in a case of schizophrenia].
Protection of life had long been the ultimate goal of medicine. Recently, patient's subjective judgement and self-determination also became another alternative principle. The situation is the same in psychiatry. Now, most patients with "wish to die" live in community, unless they show strong and urgent suicidal attempt. Meanwhile, "right to die" based on patient's self-determination has been established in the terminal state of cancer. Based on the same logical formulation, the "right to kill oneself" for patients with "intolerable psychological pain", is also asserted. Suicide as a right is now an impending agenda in psychiatry. A case of schizophrenia, who had killed her mother and who had "wish to die", was presented and discussed here. Conclusions were as follows: 1) "Wish to die" was psychologically interpreted as "denial of wish to live". At least, this meant that "wish to die" was unable to be a clear and convincing evidence that "real will" to die actually existed. 2) Nevertheless, the therapist who was overwhelmed by the patient's "wish to die", felt that it was a patient's real will to die. 3) "Wish to die" was not a self-determination to die, but rather a patient's inquiry into the quality of therapy, if the therapist was able to tolerate the wish. 4) If everyone is supposed to have privacy that none can ever intrude, this right should be the one only for limiting excessive intervention of medicine, but not for helping suicide. 5) How to verbalize patient's "wish to live" hidden deeply at the very core of "wish to die" and how to support the patient's "wish to live", had a crucial importance in clinical practice of suicidal patients for therapists to confront "wish to die" together with the patient. 6) In general, it was discussed that the concept of "right to die" in suicide and in terminal states, had to be constructed in some different way.
Kumakura
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Department of Public Health, Toho University School of Medicine.
D000328:Adult; D001293:Attitude to Death; D005260:Female; D006801:Humans; D012297:Right to Die; D012565:Schizophrenic Psychology