title: Differentiating suicide from life-ending acts and end-of-life decisions: a model based on chronic kidney disease and dialysis.
abstract: 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.
authors.affiliation: Mayo Clinic, Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. bostwick.john@mayo.edu
authors.forename: John Michael
authors.initials: JM
authors.lastname: Bostwick
authors.forename: Lewis M
authors.initials: LM
authors.lastname: Cohen
mesh_terms: 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