Differentiating suicide from life-ending acts and end-of-life decisions: a model based on chronic kidney disease and dialysis.
BACKGROUND
Technological advances continue to yield life-prolonging treatments that complicate the occurrence of death. Until recently, refusal to submit to recommended care was considered suicide.


OBJECTIVE
Physicians must now decide how to respond to requests for hastened dying.


METHODS
The authors propose a four-square grid distinguishing true suicide from behaviors such as treatment termination and lethal noncompliance.


RESULTS
One axis characterizes whether actions hasten death. The other identifies how the patient's social and medical network collaborate in the decision-making process.


CONCLUSIONS
Using chronic kidney disease to model intent and collaboration, treatment is framed within a paradigm that reflects both end-of-life decision-making complexities and contemporary conceptualizations of suicide.
Bostwick
John Michael
JM
Mayo Clinic, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. bostwick.john@mayo.edu
Cohen
Lewis M
LM
D001293:Attitude to Death; D003657:Decision Making; D005065:Euthanasia; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy; D012067:Religion; D006435:Renal Dialysis / Q000523:psychology*; D012297:Right to Die; D013405:Suicide