Psychiatry and clinical neurosciences
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Psychiatry Clin. Neurosci. · May 1995
Historical ArticleDying in dignity: the pros and cons of assisted suicide.
This paper describes the historical background and the current situation regarding the practice of assisted suicide in The Netherlands. It outlines and discusses what is considered to be the 'golden standard' of conduct for doctors and other health professionals in this area, it describes experiences with the application of this standard and discusses some of the major pitfalls involved. ⋯ It is concluded that although perfect application of the 'Dutch Protocol' encourages and supports careful and responsible professional conduct regarding assisted suicide and provides satisfactory safeguards both for the patients involved, (potential) survivors and society as a whole, there are many cases where the desired perfection is far from feasible, hence assistance with suicide remains very hazardous. It is also concluded, however, that health care policy makers, as well as professionals, should confront the issue of assisted suicide, since, as the historical development in The Netherlands has shown, repression and denial implicates the worst of all possible scenarios, and does not contribute at all to the primordial goals of a humane health care system: the alleviation of suffering and the prevention of premature death.
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Suicide risk assessment may well be the most complex clinical task that mental health professionals face. Tests have shown to be of little use. To confront this complexity, assessment and prediction are best seen as interwoven with understanding suicide, a multi-dimensional malaise. ⋯ Transference and countertransference issues in assessment are noted. A case illustration to aid in clinical insight is provided. It is concluded that all assessment and prediction of suicide risk ultimately depends on the skill of the clinician.