CanJPsychiatry 2014;59(3):141147
Perspective
Suicide: Rationality and Responsibility for Life
Angela Onkay Ho, HBSc, MD1
Psychiatry Resident, Department of Psychiatry, University of Toronto, Toronto, Ontario;
1
Correspondence: Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8;
anj.ho@alumni.toronto.ca.
Key Words: suicide, ethics,
rational suicide, legal,
responsibility for life, standards
of care, guidelines, capacity,
body ownership
Received June 2013, revised,
and accepted August 2013.
www.TheCJP.ca
Objectives: Death by suicide is widely held as an undesirable outcome. Most Western
countries place emphasis on patient autonomy, a concept of controversy in relation to
suicide. This paper explores the tensions between patients rights and many societies
overarching desire to prevent suicide, while clarifying the relations between mental disorders,
mental capacity, and rational suicide.
Methods: A literature search was conducted using search terms of suicide and ethics in the
PubMed and LexisNexis Academic databases. Article titles and abstracts were reviewed and
deemed relevant if the paper addressed topics of rational suicide, patient autonomy or rights,
or responsibility for life. Further articles were found from reference lists and by suggestion
from preliminary reviewers of this paper.
Results: Suicidal behaviour in a person cannot be reliably predicted, yet various
associations and organizations have developed standards of care for managing patients
exhibiting suicidal behaviour. The responsibility for preventing suicide tends to be placed on
the treating clinician. In cases where a person is capable of making treatment decisions
uninfluenced by any mental disorderthere is growing interest in the concept of rational
suicide.
Conclusions: There is much debate about whether suicide can ever be rational. Designating
suicide as an undesirable event that should never occur raises the debate of who is
responsible for ones life and runs the risk of erroneously attributing blame for suicide. While
upholding patient rights of autonomy in psychiatric care is laudable, cases of suicidality
warrant a delicate consideration of clinical judgment, duty of care, and legal obligations.
WWW
Suicide : rationalit et responsabilit de la vie
Objectifs : La mort par suicide est gnralement vue comme un rsultat indsirable. La
plupart des pays occidentaux mettent lemphase sur lautonomie du patient, un concept
controvers relativement au suicide. Cet article explore les tensions entre les droits des
patients et le dsir ardent de nombreuses socits de prvenir le suicide, tout en clarifiant
les relations entre les troubles mentaux, la capacit mentale, et le suicide rationnel.
Mthodes : Une recherche de la littrature a t mene laide des mots cls suicide et
thique, dans les bases de donnes PubMed et LexisNexis Academic. Les titres et rsums
darticles ont t tudis et jugs pertinents si larticle abordait les sujets du suicide rationnel,
de lautonomie ou des droits des patients, ou de la responsabilit de la vie. Dautres articles
ont t reprs dans des bibliographies et par des suggestions des rviseurs prliminaires
du prsent article.
Rsultats : Le comportement suicidaire dune personne ne peut pas tre assurment
prdit et pourtant, diverses associations et organisations ont mis au point des normes
de soins pour prendre en charge les patients prsentant un comportement suicidaire. La
responsabilit de prvenir le suicide tend tre impose au clinicien traitant. Dans les cas
o une personne est capable de prendre des dcisions de traitementqui ne sont pas
influences par un trouble mental quelconqueil y a un intrt croissant pour le concept du
suicide rationnel.
Conclusions : Il y a un dbat nourri sur la question de savoir si le suicide peut jamais tre
rationnel. Classer le suicide comme geste indsirable qui ne devrait jamais se produire
soulve la question de savoir qui est responsable de la vie de quelquun et court le
risque dattribuer tort le blme du suicide. Bien que le respect des droits des patients
lautonomie dans les soins psychiatriques soit louable, les cas de suicidabilit demandent un
examen minutieux du jugement clinique, du devoir de diligence, et des obligations juridiques.
The Canadian Journal of Psychiatry, Vol 59, No 3, March 2014 W 141
Perspective
A mong mental health care providers, there is a 20% to
50% chance of patient death by suicide during ones
professional career and training.13 Institutions, professional
associations, and government bodies have outlined policies
and strategies for managing suicidal patients, with goals
of reducing suicide risk and minimizing or eliminating the
occurrence of suicides. In addition, case law has evolved
in the past few decades, allowing malpractice suits to be
filed against hospitals or clinicians treating patients who
die by self-injury deemed due to professional negligence.4
According to the American Psychological Association
Insurance Trust, suicide was the sixth most common claim,
with money paid on such claims being the second highest.5 It
is clear that there is high value placed on patients lives, and
death by suicide is widely held as an undesirable outcome.
This paper will explore the tensions between patients rights
and most societies overarching desire to prevent suicide,
with considerations of patient autonomy,6 a concept of
controversy in relation to suicide. After highlighting
historical perspectives of suicide and outlining the current
legal climate relating to responsibility for patients
lives, the case for rational suicide will be explored. The
relations between mental disorders, capacity, rationality,
and suicidality will be clarified. Lastly, this paper will
examine the implications of assigning responsibility for
individual patients lives to mental health practitioners or
institutionsincluding potentially detrimental effects on
both practitioners and patients themselves.
Historical Perspectives
Suicide has been examined from various perspectives, most
broadly categorized as moralist, libertarian, and relativist
views.7,8 For moralists, protecting life and preventing
suicide is a moral obligation. Philosophers, such as Kant,
maintain that humanity is an end in itself, meaning that
the individual should be considered an end, rather than a
means to an end.9 Thus a person contemplating suicide is
seen as using the self as a means to an end (that is, with an
expected consequence), rather than as an end itself, which
is unacceptable to Kantians. Plato emphasized peoples
obligations to society, with suicide being inconsistent
with the greater good.10 The moral perspective is evident
in countries such as Singapore and India, where attempted
suicide is a punishable offence.11,12
From the libertarian perspective, suicide can be a carefully
contemplated decision, often rationalized as a reasonable
response to avoid pain or suffering. Libertarians value
freedom of choice, and the decision to die by suicide is a
right. This attitude is reflected in countries where suicidal
behaviour has been decriminalized or euthanasia has been
legalized. Further to this philosophy, the right to suicide
includes the right of noninterference from others, although
this is not necessarily enforced in legal statutes. In Canada,
for example, where suicide and attempted suicide were
abolished as offences in 1972,13 a health care provider has
not been successfully sued or convicted for assault after
trying to prevent a patient from attempting suicide.
142 W La Revue canadienne de psychiatrie, vol 59, no 3, mars 2014
Clinical Implications
Clinicians should recognize that suicidality may
not necessarily be driven by mental illness, lack of
rationality, or lack of mental capacity.
Policies and guidelines for managing suicidality should
consider cases of rational suicide and provide a unique
approach to exploring such suicidality with patients.
Mental health care providers are encouraged to
explore suicidal ideation with patients and seek further
consultations as needed.
Attributing responsibility for a patients life is a
complex undertaking, with consequences for people
and institutions, influenced by the legal, ethical, and
professional obligations of health care providers.
Limitations
This paper is not a systematic review of the literature.
Further, suicidality is a complex topic with varying
philosophical, ethical, and legal perspectives.
This paper does not fully explore related issues such
as assisted suicide or euthanasia, do not resuscitate
orders, advanced directives, or particular cases where
terminally ill patients have comorbid psychiatric illness.
From the relativist perspective, the obligation to protect life
varies, and the acceptability of suicide depends on a cost-
benefit analysis of variables, including situational, cultural,
and contemporary factors.14 The acceptability of suicide
will depend on the needs of the individual, the family,
and society in that moment,8 meaning that the cost-benefit
analysis is influenced by a desire to maximize the social
utility of a suicide or nonsuicide.
Currently, the libertarian stance is most widely held in
Western countries, with an emphasis on patient autonomy
among bioethicists.15 As such, patients are viewed as
having ownership of their bodies and can choose to die by
suicide. The late Dr Thomas Szasz criticized psychiatry
for medicalizing suicide to be a mental illness or disease,
describing psychiatrists as coercively gaining control over
suicidal patients by becoming responsible for their lives
and using suicidality to justify involuntary hospitalization
and treatment. Moreover, he disapproved of the language
used to describe self-killing because committing suicide
suggests an act of badness or madness, akin to a crime.16
The Liberterian viewpoint corresponds with that of many
contemporary suicidology academes, leaving mental health
clinicians in a bind when considering competing clinical
and legal pressures.
Legal Perspectives
Most data in the literature relate to the legal climate in the
United States. Although current law typically does not hold
one person responsible for the acts of another, suicidal acts
and self-destructive acts appear to be an exception.17 Claims
arising from patient suicide are the most frequent type of
malpractice lawsuits filed against psychiatrists, typically
arising regarding inpatients and recently discharged
www.LaRCP.ca

inpatients, although there is increasing risk of lawsuits
against clinicians treating outpatients.5,18,19
Many malpractice claims focus on issues relating to
negligence, such as foreseeability and causality,20 based on
a premise that most suicides are preventable if foreseeable
and if appropriate steps are taken to prevent suicide.
Current standards of care for managing inpatients exhibiting
suicidal behaviour have developed in response to input from
professional organizations, clinical practice experience,
case law, legal commentary on case law, and suicidologists
commentary on cases settled outside of court.21 Guidelines
from the Canadian Psychiatric Association recommend
aggressive treatment of people with depression who
are suicidal.22 However, it should be noted that practice
guidelines do not conclusively or exclusively represent the
standard of care,18 defined as the degree of care which a
reasonably prudent person should exercise under same or
similar circumstances23, p 1404and which is not equivalent
to ideal or optimal care either. The duty of care required
is proportionate to a patients needs, based on history and
mental status.21
For inpatients who have been identified as being suicidal,
the hospital is responsible for safe-guarding the person
from self-inflicted injury or death.24 Following a patients
suicide, psychiatrists and health care facilities may be
targets of lawsuits, with allegations of failure to take an
adequate history, failure to foresee the potential for suicidal
behaviour, failure to supervise a suicidal patient adequately,
or failure of the duty to protect from self-harm.19,2429 A
hospital may be found liable when adequate standards for
protection are not followed; however, if reasonable steps
were taken to assess and supervise a suicidal patient, a
hospital will typically not be found liable.29 For outpatients
who have been identified as suicidal, treating psychiatrists
have a duty to take protective measures,30 but may be
subject to allegations of failure to properly assess the need
for psychopharmacological intervention, use of unsuitable
pharmacotherapy, failure to safeguard the outpatient
environment, or failure to specify criteria for and to
implement hospitalization.19
The Canadian medical liability model strives to balance
patient safety and prevention, care provider or institutional
accountability, and liability and compensation.31 Physicians
are not expected to be infallible in predicting suicide, but to
demonstrate a reasonable degree of skill, knowledge, and
care that would reasonably be expected of a practitioner
of the same experience.32 Although suicide is a multi-
faceted, multi-causal product that cannot be predicted
reliably,19,28,33,3437 the law focuses on proximate cause.38
Mental health professionals are held responsible for
identifying potential risks for suicide and preventing
suicide, with the rationale that failing to assess for
suicidality leads to a failure to implement management
plans that could have reduced the risk.20 However, it is
recognized that hospitalization itself does not necessarily
prevent suicide.5 Clinicians face clinical pressures to avoid
hospitalizing patients unnecessarily, yet can be threatened
www.TheCJP.ca
Suicide: Rationality and Responsibility for Life
by legal liability if they do not hospitalize people who are
suicidal,39 leading to criticisms that psychiatric practice
is becoming influenced by political, legal, and regulatory
factors, rather than scientific evidence.40
Differentiating Mental Illness
From Incapacity and Irrationality
Clinically, suicidal behaviour has mostly been viewed as a
manifestation of distress or disorder in ones mental state.34,35
Most guidelines for managing people with suicidal ideation
and suicidal behaviour are written based on the perspective
that suicidality is driven by a mental disorder, with a lack
of capacity for informed and rational decision-making
processes regarding suicide. It is argued that the transforming
effects of an illness, such as depression, for examplewith
constricted cognitive and psychological perspectives
compromise patient autonomy rights, therefore justifying
a mental health clinician or hospital to assume ownership
of the patients body to prevent suicide15; however, even
in cases where one has received psychiatric treatment for
mental illness and is no longer suffering from disordered
affect or thinking process and is therefore capable of making
informed decisions, a persons symptomatic recovery may
still be accompanied by a view of the future being hopeless
and therefore unworthy of continuing.36 Thus the focus
shifts to whether suicide driven by psychological painbut
not a diagnosable mental disorderis a voluntary decision
made with full appreciation of the possible benefits, risks,
and consequences.
Mental illness is often equated to irrationality, most often
in cases of schizophrenia, but it has been argued that more
attention should be paid to isolated irrationality rather than
assuming global irrationality.37 Specifically, a diagnosis
of schizophrenia does not necessarily constitute global
irrationality because one may still have a connection with
reality, despite disorganized speech and behaviour. Likewise,
a person with delusions may misinterpret or misattribute
the importance of stimuli or events, yet maintain a rational
response that demonstrates coherence between beliefs
and actions.41 For example, in response to persecutory
delusions, desire to die by suicide could be argued to be a
logical means of self-protection to escape persecution. Thus
reasoning processes can remain intact despite anomalous
perceptual disturbances or specific delusions isolated to
one theme42: the decision to die by suicide may indeed be
internally consistent with the original persecutory delusion,
making the decision to die by suicide acceptable owing to
coherence rationality. However, most would agree that the
irrationality of the delusional foundational belief supersedes
the rationality of the subsequent beliefs and actions.
While legal statutes facilitate involuntary hospitalization
for those who are at serious risk of harm to self due to
a mental illness, little is said about managing cases of
suicidality in people without mental illness and with intact
mental capacity, and who should therefore be able to make
rational decisions.
The Canadian Journal of Psychiatry, Vol 59, No 3, March 2014 W 143
Perspective
Rational Suicide
As a human virtue, rationality is typically upheld as a
positive attribute, and in some instances, it may also be
superseded by moral considerations.43 For example, a
proposal to die by suicide as a means of protecting or saving
others lives could likely be viewed as altruistic, rather than
irrational. Rationality also requires logical consistency
between ones behaviours and first-order desires or goals.44
Following this, death by suicide may arguably be justified
to achieve a higher-order goal of reducing suffering.43
A discussion on rational suicide is warranted after
recognizing that mental illness does not automatically lend
itself to irrationality: people without psychiatric illness can
freely desire suicide or a hastened death based on carefully
contemplated, logical decision-making processes. This
concept is most commonly described in cases of people
with terminal illness and no comorbid psychiatric disorder
who wish to speed up the dying process by receiving aid
in dying or by having life support withheld or withdrawn.
Assuming that the decision is uninfluenced by the coercion
of others, the desire for hastened death is considered
a rational decision to avoid the unbearable suffering
associated with terminal illness.45 To acknowledge this
perspective, organizations such as the Oregon Department
of Human Services have modified terminology to no longer
refer to cases of hastened death by terminally ill patients as
suicide.46
Among clinicians serving patients with chronic, treatment-
resistant mental illness, there is increasing interest in
recognizing that the suffering due to a mental disorder may
be akin to suffering from a terminal illness.45 Desire to
escape unendurable suffering, regardless of etiology, could
then be seen as a rational response.
An enlightening discussion on the topic of rational suicide
and autonomy is further highlighted in the Canadian case
of Amy,47 an elderly woman with lymphoma who declined
treatment, and who was admitted to hospital after an
extensively planned suicide attempt. She was noted to have
paranoid and eccentric traits, and after multiple consultations
and assessments, she was deemed to not be suffering from
an identifiable psychiatric illness. Her case was discussed
in rounds with ethics and psychiatric representatives, with
her ongoing desire for suicide found to be rational. She was
discharged from hospital after indicating that she would
not take her life, but her body was found in the harbour
soon afterwards. Subsequent discussions regarding this
case have challenged the long-held belief that suicidality,
in and of itself, is evidence of mental illness, citing the
importance of respecting individual patient values, which
may not be aligned with the cultural norm48; however, in
one large-scaled study of suicides in Missouri,49 based on
interviews with family members and other collaterals, the
overwhelming majority of suicides were associated with
affective or alcohol-related disorders, suggesting that
rational suicide is rare at most.
With the predominant attitude of suicide being irrational
and due to mental illness, current practice guidelines for
144 W La Revue canadienne de psychiatrie, vol 59, no 3, mars 2014
managing patients with suicidal behaviours do not address
the concept of rational suicide.50 Recommended standards
of care for psychiatric in- and outpatients recommend that
clinicians form an understanding of legal perspectives of
suicide, legal definitions of negligence, common causes of
malpractice actions, and duty to prevent suicide through
reasonable care and skills, in addition to understanding
assessment, intervention, and postvention procedures.21,51,52
Unfortunately, psychiatrists and other mental health
professionals may not have sufficient training to distinguish
between people whose suicidal intent is freely chosen,
compared with influenced by psychiatric illness.53,54
Proposed guidelines to assist mental health professionals in
assessing people considering a hastened death or rational
suicide have been drafted, but these pertain to assisted
death, rather than individual suicide.55 These guidelines may
ultimately influence national associations or organizations
to develop codes of ethics in discussing rational suicide by
the individual.
Responsibility for Life and Suicide
The Canadian governments lack of support for suicide
research has been criticized, with gaps in the literature in areas
including policy research.56 In 2012, however, the Federal
Framework for Suicide Prevention was enacted,57 indicating
that suicide prevention is everyones responsibility and
articulating the governments responsibility in defining best
practices for the prevention of suicide along with promoting
information dissemination and research. The Joint
Commission on Accreditation of Healthcare Organizations
mandates that health care organizations identify patients
at risk for suicide while they are inpatients or following
discharge. It is expected that organizations perform a
risk assessment, address immediate safety needs with the
most appropriate treatment setting, and provide suicide
prevention information on discharge. The rationale for this
process is that suicide is one of the most frequently reported
sentinel eventsunexpected occurrences involving death
or serious physical or psychological injury.58 Similarly,
health care quality organizations consider inpatient suicides
or attempted suicides resulting in serious disability to be
preventable events.59 This perspective may influence the
provision of care and practice of medicine to be more
defensive on the part of clinicians, with sequelae that
may be harmful to patients, including removing patient
autonomy and impeding patient-centred care.
In considering cases where people without identified mental
disorders are suicidal, there is no current legal obligation
to involuntarily hospitalize or intervene to prevent death;
however, perspectives from case law and guidelines
regarding managing suicidal patients all suggest that the
mental health professional has a responsibility to intervene.
This is where risk management protocols begin to encroach
on the right to suicide and respect for autonomy, as it may
not seem justified to remove a persons autonomy.60
Conversely, upholding patient autonomy with no limit can
place unreasonable demands on health care providers.61
www.LaRCP.ca

For example, a patient who attempts suicide but creates a
living will to reject life-saving treatment leaves clinicians
having to reject their human instincts to assist others and the
principle of beneficence, begging the question of to what
extent should a suicidal patients rights be protected? With
libertarian views, patient autonomy has begun to trump
clinical duties to protect life.6
Further, by setting a standard of suicide being an event
that should never occur, it raises the question of who is
responsible for a persons life, with a risk of erroneously
attributing blame for suicides. This perspective presents
death as the greatest of harms, possibly ignoring the
legitimacy of unendurable psychological suffering as
being equally harmful. Thus, for a suicide to qualify as
rational, clinicians must recognize that the aim of ending
psychological or physical suffering may be a worthy reason
for suicide. Likewise, death would no longer be necessarily
viewed as a harm or failure.62,63
Given the spectrum of risk of harm to self, the threshold
or the criteria for intervening are unclear. In considering
broader societal examples, people may pose harm to
themselves by participating in dangerous extreme sports,
making poor health choices, or self-harming. Although
the risk of death may be higher from dangerous sporting
activities, there is no legal impetus to prevent one from
participating. Clearly, the risk of harm from such different
activities is variable, yet there is no clear correlation
between the potential seriousness of harm and the degree
of rights removed.14
Over time, hospital policies have shifted to encourage
patients own responsibility for their treatment,
therefore no longer requiring strict observation and
overly restrictive environments in all cases where
the patient is suicidal.64 Patients admitted to hospital
have responsibility for their lives returned if they are
able to manage their emotions, impulses, and suicidal
tendencies.51 Involuntary hospitalization as a reflexive
response to any suicidal intent has been discouraged, in
particular when considering that this action may restrict
the autonomy of a person with a terminal illness who
desires a dignified death.54,65
The use of hospitalization and environmental restrictions,
constant observation, and removal of access to a means
of suicide can be helpful in some circumstances, but
there is no guarantee that suicide can be prevented
even with such extensive interventions.20,51,66 Routinely
ordering excessive precautions or avoiding treatments
as attempts to limit liabilityrather than using rational
decision-making processescan be catastrophic without
necessarily preventing allegations of negligence.20 Indeed,
hospitalization itself can also present risks to the patient,
including promoting regression and dependency.64,67 With
increasing duration of hospitalization, some patients
report suicidal preoccupation after they perceive no lasting
improvements from therapy.51
www.TheCJP.ca
Suicide: Rationality and Responsibility for Life
Discussing Suicidality
Discussing suicide and end-of-life care (including assisted
death) with patients is not necessarily illegal or unethical
in Canada, but major national mental health organizations
do not have a consistent position on how to approach
these discussions to assess a patients personal beliefs
and decision-making capacity. It has been argued that a
responsible mental health professional should be willing
to engage in an open discussion with a client about their
desire to die even though the clinician may not condone
it or be legally allowed to assist.65 Further, it is suggested
that not discussing these options may be disrespectful of a
patients needs and shirking professional responsibilities.55
From a holistic existential therapy perspective, exploration
of existential coherencehow one coheres to the external
worldis encouraged.68 The innermost layer of existential
coherence deals with the core question of whether one
wants to live or die, and it is believed that suicidal crises
arise from people questioning whether they wish to accept
responsibility for their lives. It is hoped that by providing
support to a suicidal patient by exploring fundamental
issues of existential coherence and emotional pain, he or
she will ultimately choose to live, rather than use death to
avoid confronting these issues.
Principles of the recovery framework in mental health are
increasingly used to focus on peoples journeys, without
prescribing rigid instructions on how to support people
with mental illness.69 The focus on increasing control,
meaning, and purpose in ones life is a perspective that
may be helpful for difficult discussions regarding life
and death.
Overall, the therapeutic relationship between a suicidal
patient and clinician has been emphasized as being critical
to restoring a patients sense of well-being and self-worth
to address suicidality.4,70 It is suggested that acting in the
patients best interestsrather than following rigid rules or
guidelines out of contextwill almost always lead to the
best course of management.71
Conclusions
While upholding patient rights to autonomy in psychiatric
care is laudable, cases of suicidality warrant a delicate
consideration of clinical judgment, duty of care, and
legal obligations. Current mental health treatment
guidelines and legal statutes do not adequately consider
the complexity of suicidality, including the potential
for suicidality made under free will, uninfluenced by an
identified psychiatric disorder. A further demand on mental
health professionals to protect patients from or prevent
rational suicide can have various sequelae by impinging
on patient autonomy, promoting excessive use of health
care resources, and increasing risk of legal liability. The
impact on care provided to patients, patient rights and
responsibilities, as well as care providers attitudes and
approaches to managing suicidality comes with potential
risks that cannot be taken lightly.
The Canadian Journal of Psychiatry, Vol 59, No 3, March 2014 W 145
Perspective
Acknowledgements
No funding was provided for this research. A previous
version of this paper received the 2013 Isaac Sakinofsky
Essay Prize in Suicidology, presented to a resident,
sponsored by the Centre for Addiction and Mental Health,
Faculty of Medicine, University of Toronto.
The views presented in this paper do not necessarily
represent the views of the author, the Centre for Addiction
and Mental Health, the Faculty of Medicine, University of
Toronto, or the Department of Psychiatry, University of
Toronto.
The author thanks Dr Michael Gillette, Dr Isaac Sakinofsky,
and Dr Ivan Silver for their advice and support.
References
1. Prabhakar D, Anzia JM, Balon R, et al. Collateral damages:
preparing residents for coping with patient suicide. Acad Psychiatry.
2013 May 7. doi: 10.1176/appi.ap.11060110. Epub ahead of print.
2. Chemtob CM, Hamada RS, Bauer GB, et al. Patient suicide:
frequency and impact on psychiatrists. Am J Psychiatry.
1988;145:224228.
3. Ruskin R, Sakinofsky I, Bagby RM, et al. Impact of patient
suicide on psychiatrists and psychiatric trainees. Acad Psychiatry.
2004;28(2):104110.
4. Wettstein RM. Psychiatric malpractice. Washington (DC):
American Psychiatric Press; 1989.
5. Bongar B, Maris RW, Berman AL, et al. Outpatient standards
of care and the suicidal patient. Suicide Life Threat Behav.
1992;22(4):453478.
6. Doyal L, Sheather J. Mental health legislation should respect
decision making capacity. BMJ. 2005;331:14671469.
7. Khan MM, Mian AI. The one truly serious philosophical problem:
ethical aspects of suicide. Int Rev Psychiatry. 2010;22(3):288293.
8. Mishara BL, Weisstub DN. Ethical and legal issues in suicide
research. Int J Law Psychiatry. 2005;28(1):2341.
9. Kant I. Second section: transition from popular moral philosophy
to the metaphysics of morals. In: Abbott JK, editor. Fundamental
principles of the metaphysics of morals. New York (NY): Liberal
Art Press; 1949.
10. Bluck RS, editor. Platos Phaedo. Indianapolis (IN): Bobbs-Merrill;
1955.
11. Singapore Penal Code. Chapter XVI: offences affecting the human
body, s309, (1871, rev ed 2008).
12. Indian Penal Code, Act 45 of 1860, Chapter XVI: of offenses
affecting the human body, s309 (1860).
13. Parliament of Canada. Of life and deathfinal report. Appendix D:
chronology of major Canadian development and events [Internet].
Ottawa (ON): Parliament of Canada; 1995 [cited 2013 Aug 16].
Available from: http://www.parl.gc.ca/content/sen/committee/351/
euth/rep/lad-a2-e.htm.
14. Cutcliffe JR, Links PS. Whose life is it anyway? An exploration
of five contemporary ethical issues that pertain to the psychiatric
nursing care of the person who is suicidal: part one. Int J Ment
Health Nurs. 2008;17(4):236245.
15. Beauchamp T, Childress J. Principles of bio-medical ethics. 7th ed.
Oxford (GB): Oxford University Press; 2012.
16. Szasz T. Fatal freedom: the ethics and politics of suicide. Westport
(CT): Praeger; 1999.
17. Meyer RG, Landis ER, Hays JR. Law for the psychotherapist.
New York (NY): Norton; 1988.
18. Tsao CI, Layde JB. A basic review of psychiatric medical
malpractice law in the United States. Compr Psychiatry.
2007;48(4):309312.
19. Packman W, Pennuto T, Bongar B, et al. Legal issues of
professional negligence in suicide cases. Behav Sci Law.
2004;22(5):697713.
20. Simon RI. Concise guide to clinical psychiatry and the law.
Washington (DC): American Psychiatric Press; 1988.
21. Bongar B, Maris RW, Berman AL, et al. Inpatient standards
of care and the suicidal patient. Part I: general clinical
146 W La Revue canadienne de psychiatrie, vol 59, no 3, mars 2014
formulations and legal considerations. Suicide Life Threat Behav.
1993;23(3):245256.
22. Reesal R, Lam R, CANMAT Depression Working Group.
Clinical guidelines for the treatment of depressive
disorders. II. Principles of managment. Can J Psychiatry.
2001;46(Suppl 1):21S28S.
23. Black HC. Blacks law dictionary. Abridged 6th ed. St Paul (MN):
West; 1979. Standard of care.
24. Robertson JD. Psychiatric malpractice: liability of mental health
professionals. New York (NY): Wiley; 1988.
25. Schutz BM. Legal liability in psychotherapy. San Francisco (CA):
Jossey-Bass; 1982.
26. Litman RE. Hospital suicides: lawsuits and standards. Suicide Life
Threat Behav. 1982;12(4):212220.
27. Maris RW. Forensic suicidology: litigation of suicide cases and
equivocal deaths. In: Bongar B, editor. Suicide: guidelines for
assessment, management and treatment. New York (NY): Oxford
University Press; 1992. p 235252.
28. Winger v. Franciscan Medical Centre, 701N.E.2d 813. Ill. App. Ct.
3rd Dist; 1998.
29. VandeCreek L, Knapp S, Herzog C. Malpractice risks in the
treatment of dangerous patients. Psychotherapy. 1987;24:145153.
30. Bellah v. Greenson. 146 Cal Rptr: 81 Cal.App.3d 614; 1978. p. 535.
31. Canadian Medical Protective Association. Medical liability:
a physician primer [Internet]. Ottawa (ON): Canadian Medical
Protective Association; 2006 [cited 2013 Aug 15]. Available from:
http://www.cmpa-acpm.ca/cmpapd04/docs/submissions_papers/
com_medical_liability_a_physician_primer-e.cfm.
32. Canadian Medical Protective Association. Forseeability: what is
expected of a physician? Ottawa (ON): Canadian Medical Protective
Association; 2009.
33. Shneidman ES. Definition of suicide. New York (NY):
Wiley-Interscience; 1985.
34. Khuri R, Akiskal H. Suicide prevention: the necessity of treating
contributory psychiatric disorders. Psychiatr Clin North Am.
1983;6(1):193207.
35. Shneidman ES. Psychotherapy with suicidal patients. Suicide Life
Threat Behav. 1981;11(4):341348.
36. Blumenthal SJ, Kupfer DJ. Suicide over the life-cycle. Washington
(DC): American Psychiatric Press; 1990.
37. Cholbi M. Tonkens on the irrationality of the suicidally mentally ill.
J Appl Philos. 2009;26(1):102106.
38. Thomson West Staff, editors. Proximate cause, sec 436438. 57A
Am Jur 2d. St Paul (MN): Thomson West; 2004.
39. Perr IN. Legal aspects of suicide. In: Hankoff LD, Einsidler B,
editors. Suicide: theory and clinical aspects. Littleton (MA): PSG
Publishing; 1979. p 91100.
40. Linde P. Danger to self: on the front line with an ER psychiatrist.
Berkeley (CA): University of California Press; 2010.
41. Hewitt J. Schizophrenia, mental capacity, and rational suicide.
Theor Med Bioeth. 2010;31(1):6377.
42. Mahler B. Delusions: contemporary etiological hypotheses.
Psychiatr Ann. 1992;22:260268.
43. Culver CM, Gert B. Philosophy in medicine: conceptual and ethical
issues in medicine and psychiatry. New York (NY):
Oxford University Press; 1982.
44. Frankfurt HG. Freedom of will and the concept of a person. J Philos.
1971;68(1):520.
45. Werth J Jr, Gordon J. Rational suicide? Implications for mental
health professionals. Washington (DC): Taylor Francis; 1996.
46. Dunn P, Reagan B. The Oregon death with dignity act: a guidebook
for health care professionals [Internet]. Portland (OR): Oregon
Health and Science University: Centre for Ethics in Health Care;
2008 [cited 2013 Oct 28]. Available from: http://www.ohsu.edu/xd/
education/continuing-education/center-for-ethics/ethics-outreach/
upload/Oregon-Death-with-Dignity-Act-Guidebook.pdf.
47. Cameron S. Learning from Amy: a remarkable patient provokes
anquished debate about rationality, autonomy, and the right to die.
CMAJ. 1997;156(2):229231.
48. Cameron S, Watler CL, Gervais L. Lessons from Amy [letters and
response]. CMAJ. 1997;157(1):13.
49. Robins E. The final months: a study of the lives of 134 persons who
committed suicide. New York (NY): Oxford University Press; 1980.
www.LaRCP.ca
 Suicide: Rationality and Responsibility for Life

50. American Psychiatric Association (APA). Practice guidelines for
the treatment of psychiatric disorders: compendium. Treatment of
patients with suicidal behaviours. Arlington (VA): APA; 2003.
51. Silverman MM, Berman AL, Bongar B, et al. Inpatient standards of
care and the suicidal patient. Part II: an integration with clinical risk
management. Suicide Life Threat Behav. 1994;24(2):152169.
52. Bongar B, Greaney SA. Essential clinical and legal issues
when working with the suicidal patient. Death Stud.
1994;18(5):529548.
53. Werth JL Jr. When is a mental health professional competent
to assess a persons decision to hasten death? Ethics Behav.
1999;9:141157.
54. Werth JL Jr, Holdwick DJ. A primer on rational suicide and other
forms of hastened death. Counsel Psychol. 2000;25(4):511539.
55. Werth JL Jr. Mental health professionals and assisted death:
perceived ethical obligations and proposed guidelines for practice.
Ethics Behav. 1999;9(2):159183.
56. White J. Suicide-related research in Canada: a descriptive overview.
Montreal (QC): Public Health Agency of Canada; 2003.
57. Government of Canada. Federal Framework for Suicide Prevention
Act, s.c. 2012, c. 30, (Dec 14, 2012).
58. The Joint Commission. Hospital National Patient Safety Goals.
Oakbrook Terrace (IL): The Joint Commission; 2013.
59. National Quality Forum. Serious reportable events in healthcare:
2006 update. Washington (DC): National Quality Forum; 2007.
60. Werth J Jr, Gordon J. Helping at the end of life: mental health
professionals and hastened death. Innovations clinical practice:
a sourcebook. Sarasota (FL): Professional Resource Press;
1998. p 385398.
61. Shepherd L. Asking too much: autonomy and responsibility at the
end of life. J Contemp Health Law Policy. 2009;26(1):7281.
62. Cameron S, Dunn R. Touched and troubled by Amy [letters and
response]. CMAJ. 1997;156(8):1116.
63. Nordenfelt L. Rationality and compulsion. Oxford (GB):
Oxford University Press; 2007.
64. VandeCreek L, Knapp S. Malpractice risks with suicidal patients.
Psychotherapy. 1983;20:274280.
65. Leeman CP. Distinguishing among irrational suicide and other forms
of hastened death: implications for clinical practice. Psychosomatics.
2009;50(3):185191.
66. Pokorny AD. Prediction of suicide in psychiatric patients: report of
a prospective study. In: Man RW, Berman AL, Maltsberger JT, et al,
editors. Assessment and prediction of suicide. New York (NY):
Guilford Press; 1992. p 105129.
67. Gutheil TG. Argument for the defendant-expert opinion: death in
hindsight. In: Simon RI, editor. Review of clinical psychiatry and
the law. Washington (DC): American Psychiatric Association;
1990. p 335339.
68. Ventegodt S, Merrick J. Suicide from a holistic point of view.
ScientificWorldJourna1. 2005;5:759766.
69. Canadian Mental Health Association (CMHA). Recovery [Internet].
Ottawa (ON): CMHA; 2013 [cited 2013 Aug 16]. Available from:
http://www.ontario.cmha.ca/about_mental_health.asp?cID=7667.
70. Maris R, Berman A, Maltsberger J. Summary and conclusions: what
have we learned about suicide assessment and prediction? In:
Maris RW, Berman AL, Maltsberger JT, et al, editors. Assessment and
prediction of suicide. New York (NY): Guilford Press; 1992. p 640672.
71. Hoge S, Appelbaum P. Legal issues in outpatient psychiatry.
In: Lazare A, editor. Outpatient psychiatry. Baltimore (MD):
Williams & Wilkins; 1989. p 605621.

T H E C A NA D I A N J O U R NA L O F

PSYCHIATRY
LA REVUE CANADIENNE DE

PSYCHIATRIE
Tirs part sur papier et virtuels
Des tirs part sur papier glac,
des documents PDF, et Can
CanJ
JPsych
CanJPs
CanJP
iatryy 2014;59
ychiatr
201

hiatry 2014;5
sychiatry
Psyc
4;59(3
(3):1 140
2014;59(3
):131
9(3):131140

Ammon
1140
):13 140
31

ongg Inpatient
ients
Inpat nts CPsych
s FR
1

d, Hig
h Ris
k Con
sultatio
n Clin
ic, Cen

ic, Cen
tre for

tre for

idee A pa), tie

tion Clin
view

la permission de reproduire des articles,

Hea
C, ction ario; 1
w
ongM(In
Consulta
Revie icid FRCP FRCPsych
ieww
o, Ont
InRe
Re
Revvie Suic nts ant fra in Risk
In Londatie
Toront for

tingggSu
In import rature d, High
In
n Su ici de Among, DP Inp FRCP
C,
sych ically e lite of Tor
atient
onto,
nto rio; 1Hea
.ca.
ultation
Clinic,
Centre

Am
Onta

re
Pev ve
even tin
ting Suicid
entin e MD M( Lo nd),
CPC,
FRCP small
but clinprehensiv vent inp
es, Uni
versity
pre nt frac
tion nto,
kino
Toro
fsky
@utoro
nto,
. , High
Risk Cons

Pr ChB, , DP ond), FR
enc of Toro Head
ately of the comdonelytoimporta ature in ge,
c.sa for
Ontato.ca
ven ersity; isaa rio; 1
Pr
Pre y, MB B, MD
ofsk MBCh MD, DP
M(L
d), FRCPC, es a
h
FRCPsycproportion is
lth Sci
lic Hea arionces
analys atllcan
Pub o, lth be ical
. , UnivT 1R8
but clin hensive t of
liter
OntScie ON M5 rsity of Toron owled
Kntien
t e
c.sakino
b inpa ion suicid
fsky@ut
to, Toron
to, oron
High Risk
Consultation
Clinic, Centre

kinofsky, chiaCh B,), Torlicont

try and Hea ont(Lon
DPM
o, Unive1R8; isaa ronto.ca.
, Ontario
pris
; Head, tive
ately wh
sma compre to pre e, We
ven fract
rtantinp atient cide
qualita
MB Tor rio. ces,
Sakin or y,
MHPubMD, , Toronto@uto
wn and s of the

tableaux, figures, et autres documents

h ScienON M5T
nto,et,Onta
acSa ino fsk of Psy lthtry
(CAand
hB, cStre
Healt .sakineofsky
of Toronto com
as aa ca. portion e impo
callybas
don , of ture inh sui ,
lMBC
nto, es, Universityisaac
Isa , Toro 1R8; nt suicid nded oronto. is kno analysi tllcan ed, Emensi
chia pro
Isa acac Sak nofs
Pro fessky,
r of Psy
Hea (CA ColPubli
MH)
and lege
to,
Toro
et,Onta rio.
Scienc M5T es at ive but
bM
be
clini tro lledlitera
ve cal ly wit wledge
tient
Isac1 Em
Isaa Saki us
erit Prof essoMe nta hiatry
lth 250
Heaatry, and
oftalPsyc
CAMH
H),
Stre
Toron
ege
Public Health
Toronto, .
ON
Inpatie iside
dy akinofs
intecom pris
ky@ut g wh
qualitat nateand
sma
ly wha Pu compreh
y, the y con speent cifib of Kno
inpa n suicide ed.
hligdhtin ferabl dea tient sea
n and Coll
ritus
1 Eme ictio Profe ssor
Men Psychi
ce:
ofal Healt
(CAM
H,h 250 ), ge Stree, t,Ontario ON tiv M5T e: 1R8; isaac.s
is stu
nt suic hignde as aa prop ortio
is knoe ane
wn Lib rarof e, We
ltprev
toimpor tantinpa fractio rch
itus n andsorden Colle Toronto Toronto Ob, jeccid: e. s ysisies , pre be doneo llybas in suicide
what itativ
1 EmerAdd Profes
1 Emeritusictioand Ment CAM 250 (CAMH Thatie ge,inte chr anal ser Em
clinica
als of
pon
ndence:
AddtionresMental HealthH,
e: CAM, 250 College Street,
Inp gua y iside comprise t can
but Me y d, led, literature rature
with
Addic Cor
anddenc
espo jecsui tive hslan stud lightingas aaqual the Cortiona tely wha
ort small Pub the control sive ally lite wledge,mises,
Thitient suic
on
Addicti
Corr
Correspon ce:
CAMH Obof glis e, highdedrises rch of propo on coh n and ary, ess comp blyrehen ofntthe
s cific
Knoent
inpati
of pre
Corresponden the e: EnInpa
ide. uagy is inten t issknow necid sisunl
Libr
e, of the
prebe fera to spe
ltpreve
ing Web
but off suic ide and
tients, Obje of ctiv
suic lang eaticcomp sea ingawha article ative hraanaly ies,can done dea ase, rdtient rched.
ion
inpa s, e. ent
cidlish
This studsuicid
high lightas for qualit
themp Coc ted sui ort serwhatss Medy alsothe find d, of wa
, Emb inpa re iss
sea
ide
ide,
: suic inpatient tive:
of suic
the Eng
ide.
sui Inpati system
uage ,intend edse rchwhatofatte on coh
is known
and ry, Pub the
ed only controlle on the liter adm
ratu
with suic , mees, nt,
ness
Objec d: A isal atic
lang databa sea e Libra unle llyafte ledge iron

protgs par un droit dauteur

Wo rds tion ients,
ide, Eng e.Me lish
ide.
Thisthostudy htingarm
or
articles hransuicide, ted
baserab
s,, pref ur not spec
tings Web ofifica
the
of Know
rtly envpre
e off mis
e aware l
Key ds:presuic
e,ninpat
ven thesuic
of suicid age,
persyssontemhighligsel f-hse for
of the Coc ted rt serie
sen ly occ
Emba
also deal
findse, ur sho a saf
ent
but suicid nt, and.ica
Key
Wor s: suicid
ide entio nts, ide.hand langu
d:a A e aba ch atte on ncoho mp is pre PubM ed, the occ ofing
ual
they inpati d essissi meon ched
Word
suic prev , inpatie
, and 3. the
Englis
suic Metho alratdat
tic sear or les sioane y, ss act on aks lled, the war sear e te clin
Keysuic
Key Words
: suicide
ide ntion son
del
t syst
ibe
ema -harm artic
Librar
ide, unle
cid,es basded
, prefer
edably. Pecontro on hav
by ass
lwith
litera suicid
ture
r adm quame nt,
Aper basehfor discus
Cochr theefu
preve rdspecifi cally
suicide tion d, revised
suicide preven eiverevis
andber 201 suicid Met
e.hod(no
and a: a). ate
data
self
searc of the
tiveattem pted suic pre nt suited
series
t sen con occ
the urwanot
dealt ngs sho
ely
of
, car
rtly afte
and
adeiron
env ises,reness
ed,tem 3. ber
delional atic litaor cohor
atie
s oninpis had abs also findiriat
ur prem
Rec d, eded,Sepand 201
tember andd: (no tdat
system
a Apers : Aase harm
qua for article k ofion
uss e, unles
they
sactu
e risk
ally
d on
on the rop
ks occ nicingatioan,safebut offment, awa
andical
Rec eiverevis
eptSep 2013. Metho erat eltsself-
datab bulpted
edisc ve torsuic
suicid ides
d,cidbase . Pea app onmuhav
the ward essissio
searc n hed.
clin
ived,
Receacce pted , and
acc
September
revised a perso a).
delib
dat nal su oriveThattem leatien ente sui dedients war r not d by
com l ass
literat admure quateent,
Received, 2013. and(not Re qua arm litat
ions: t wa sofoninpa
on is pres uce abscon g pat occu
theand gs ofcar tlyefu
the after aderonm
acceptedSeptember ). rate self-h: Alus ussi to redhad isinactu ally
onorkthe findin shor
riatrely, , andoff envi ses,reness
accepted delibe
(notdata Results Conc itativ pat
Theeien disc
bulk sible e or erv
leav ides
sup
suic based
ide
nted,
suic
riskon
teamw ksrop
d ient
occu
d. Pea s app by ngtiona safe
but
havinica
premiawa
ward ent, and
A qual
:clu siothe ns: is pos on tient
isibil ity,uce
prese , goo onde onmu the ssmsion
clinical
Results
data). when It was
. bulk
discus
ient sion
of inpa
t evis toe red riskabsc g patlly occur
theand ward not
com
y ful
after asse admisuate
Conqualit rge or ehad isin care adeq nment,
WW
A ndis the ative
cha :pat
The paton ien
siblleav cid erves risk onork opria
actua
teamw
shortl
tely, lement
Resu lts:clus
Conwhe
ions zin isg pos sui
ent y, ce supsuic
suicid ide dnded. appr occur
Peaks W g on,
a safe andenviro nesstionnel analyse
imint It was t forbilit
of inpati , goo patie nts havin icati s t, aware
italis
ge.
patie
opt
har bulk pec visi
to redu absco bymun smen por
ndiscthes: The resient
pat ible
suicide
or had riskrvisiengrisk on the ward
work and
com l asses n prol veut une et ce qui
hosp
lusion
whe andis poss on.for leave ly, carefu clinica
e.ofItting W
Conc was supe fractio
ate nu
W Wunica ntstion,
ility, de se est conent

sont disponibles
imiz e suicid
whendisc
patien
theharg
opt pec
nt t
entvisib
le to reduc good teamts appropriate and adequ une
patie ente s Cette tuce qui
atm
res ide risk, em
istre
Itand patie
possib vising patien and comm tionnell
discha rge.ofizing
optim tnt.
ect for suic ity, super teamwork les liss spi
reprs talis cide. ageant propor t une ana bM
lyse
ed,
e risk, good de chez W W pita
visibil
W
tme
nts ho
resp ce qui
and
optimofizing
patien
trea de sui e, frac dgtion se veu , Pu
et
tmen ctt.for suicid
su ici pa
ts hostie cas une
elais s. de
tu chrnu
con ane
nttrouver
des
of and respe
trea le ezpatles ien e des rs liss pita
ent
ang Cet lis
te qui yest
Coleme r
enir cidcideech
ant s rep rarnnel de
W pitaWtslis
ort
hos lanpitague tside.hos ceortio le pou yse cide cide,
entW
treatment. des
ion ant la Lib
Prv le:sui
imp suic sprop une anal
ien ure cas de
de patien dgage sonnel le sui Med,de sui
Le sui iqu em
les pat
s hos rat une e, nefract dan seper veut sur Pub
ce qui
deszpat
ient des des telais e s et ves
nir tif ide la litt nte e sen s. s u
ne,
maeis che a ss
ue ang me e tud le
hra tentativer des
Prve Objec cid
clin
tentdeimporta le sui
cidrepr
langitali hosepitaCettlisdontne est trconn
Coc enttrou
s
hosp st qui con de
:sui
ide. ary ellemles
irmo ledes Letesuiccom plments pati hosp
ven ir italis
ents re de deue suic
ient de gean
ce
la Libr
spropo
nabl entrtionn sur
e pour se cide). de herche
ven
Pr Ob suic jec tif
is chez
clin ique les
patie r prlitt ratu des tmcasatiq
des pat une bas
, dga
fractio dan
em
re
ou
nell
une analysui suic ide , la recide,
le: Lequa tesuic ide
malitaidetive des pou
e deimpo
la rtan sys te
suiclangide
reprs
etue dan
ente
angl une
aise
s mene prs. fr
tuden dlsse ib
per son
veut
shransursur le le
etPub
e, ce qui Medde suic
PrvObje enirctif modes trquem
t com
faitent
e plt hospi
tseven rec irher le che
taliss
de ge,de
e led uesuicida t
nts e.des
hosp
tu italis
Cette don atio ne
qui ryest
con Coc
es
trlconnu
ne ten ultaes
tativ
ver
ts
des
litatpeu
mais ive
e des patien
clini rla pr
Un littr aturdes
ow casatiq
tm patie
ort es, bas e deutil
tom eant la
ceent
Libra
aux
don
sur les
s lestrours
. de
suicid pou de : tante des dgag blemnt lle pour de pas
tif : este
Le qua fait
thodet impor
Kn
suicsys idedeecoh s une ise,laue fra dans ou pr suic ide) ide che ou quil

La Revue canadienne de psychiatrie.

Objecmod tre plte b leofche dan angla sur pr que.me brte e
onne , da le le suiced, nthernon
peu
itativ et com
cliniqu Memen prv e, enirher
We
rec turetu dedge langu
des , etais atst
pas hospi
tu
men
des taliss
cifidonn es dlipers s sur sur
sane, PubMts de la
suic
nne recide, g uire
modeste qualmais fait pourdebas Une
: la littra des wle ma
des (m
scoh tique
ortes,ten
patien t sp deutila tion pr senne rle
y Cochr
cont
don tives
ulta survie en con le de rd
tre
comp lteEm
tho de sur
of Kno
e systelis base tom est
la aux nt
Librar les tenta
rs rs des est
qualitativepeut M prve e, icle
We nirsberch
rech le suicid pita de et dans rapune por lau e dans
sur tive
rab leme
ent ou sur pour
rs lestrouve
pita lis ient pos sib
deoptimi sant
pour : Une art tudes
hos ge, ne se a t
is pas men
nes
prf lita
uem rennelle, daptslehos ide). de
lee pat est pas
peut tre
fait Em
Mthod Web
e bas
sur
of ien des
Kno
ts wled
systm satique
ellescoho(ma rtes, tud
t sp
sio
qua
cifiq
donn
de tilati on es dlib perso
sente sursur le
ien
suic suicid
que decon g.
rech
Ilnon
te, ,een
erch l
ou quisoignne
e,
clespat rche qulis dedans porcus ten
base omu prdonncontr esles
pat alors ives levien lanen
suicid aireg
de : ase, Une artireche hosinspita
tud es ,neet se rape une dis
sur laut ablem
ive estaux
nt ent es desurlier s, tentat
rsu ltats
n sou sur scen uritcon lua tion uire
de rd bon
MthoEmb ofient
sur des
Know
smo ledge(ma : Un
is pas squaprfr
ifiqulitateme suicid rehos oupitarsles lespita sio lis entest va
sible pe,ant une
Web lespat que lles ltats tes,uss
scohor tude spc
ion t des dlib entxe,
dapsle hos mis
suicid e). pat ient
le nem, etIlpar
une
pos qui
Embase, artic ins italisRs de su ortent mutila
.disc tion lieu surs lads env
ient queiron est pas lde
d optimis ne,
sur des ntsmo hosp
tude seUne rapp
ure sur lauto majori e ieuestaux prs
r des donn de pat esapr
conla g.
ent ent non
reche rche
travai,en ou quil
articlespatie lles ts :rat
ne
(mais
litt pas : La itativ ent ides nt peu , alor
ant un atsle
surv deienn
tem aire soig
hospi s que
taliss ulta onsqual
spcifi
ion quem
lex des
tr suicrve pita liers
s les
offr rsult sou
adqua
italis
sion scbon
un enuritcong luation rduire ne
patientsmoin sRs se re.disc
rappo ussi
rtent
nclus r ma isjorit bse nte,x hos dapr en hosp
lnts mis nt cid e, est
ent
nt ible de, une bon
va es
moins quelle
ne
ts
litt ratu
: Une Co ma
: La ative
s so
prse
est des sde
pic
lieulhpatiepita s
aprsupalors
lad
erv env isa
que
ue de
le
iron nem
patie
sui par une
poss
est pasdq
,.et. Ilnon uipe t mitte
Rsulta
e.discussio sion
lin nsieu
tr qualit ui. Les trieur suic e ides
dant peules rs, un congent ri
nnent e,ailen optimisan n com is, an
littr:aturUne Conclu ur enfritlex des cidserven ts, enen italie offrtant du risq n quaou le
tem
survie rop trav ou quiln soige ereditatio , that
ne,
Rsultats Lama
st
majois sui
soblieux ien hosp
pitalres hospi
pec taliss
issio
t ad e appnt scu
un enritair
bon conguatio cal
rie: se uepicsder des stserv
ladm iqu ide,t est val de rduir acc an SE ssphysi

Quil sagisse de documents de congrs,

espat lh patien isanclin eme
patien
littrature.
ions
lint Les
risq rieu des sde apr
unsup ent quede le suic
ronn estune possible unetalbonn
, spi
Conclus mais t enfle ui.lext suicid
ibilit
dan peuet alors
, item un envi t, et.. Ilpar as iou
rther,
s : ses La major
it des
vissuic
ide
servssa entnce
ienthospi
s, enen les
taliers tradu
offra nt risque ouapp le men ropri travaen
cong il dq uipe
optimHo isant ent, thcom or sermit tee
11, p Fu
e,ati dea
sob adquate
lintrieur lade lieux pect ission
un bonitaire, harge.soigninp
2
Lesueieur pics des nai ital et ladm
Conclusion conpat itation reo t is, anl signal
i.risq lhp n, res nt
clinique ent un scur isc ation
sesmaist enfu lelextr bilitune des
ide dans
rventmunic
peu
ce
enenles
etaprs
atio un supet rvisa ent enviro dennem suicide,
par, une postd valu whune ile an accolvreding the, tha
f.
lintrieur suic traitem un
risque ankSE they nse.
e sica
lade visisobse san ebonne
inv
enfui. le Les epics
risqu des con com
nais
patie nts,
lhpit al,
offran
et unect du adquateme appr
nt,fut
opri et
. ure
l
sui cide,
dqu .
ipe, spi
Ho
urr enc tal
nt, as
the ris iou phy
saus po
sest une
ilit e dansnicaettion resp
unsupervisant que to un bon travai rge atie, or thcom ser becees ther,res not
le risquela conn
de visibsuicid
aissmu ance en les traite ment clini ient e, , regard tdischa ed occanl inp injuryingatio deansentif.
ornelmitt
11, p Fur n and or are e
patsuicid
2
de
expe,ectwhlog
com ts, an
unedes patien et un ct du risque icappro . re, pos
ity un
ile ica accr olvedit ledSE, reo
that is, tio
iga err
la visibilit icati on,
un respe atr
chi abotout e pri
acu futu cid cho pita e l inv cal the est cal
l sig nal aus
mune et
psycliniqu is suior psy e. Hos urrenc tien ntsort,are as riskan te inv phy ediy
sica
e the ur bec
ausm

de lectures de blocs de cours, de livres, darticles

issanc the
une conna
com
tion, et unadmit atri
traitemaent
cgmpat entient safety regard discharg d occanchinju inpa every, meor diaserio us
ittees
bec and ntsponoccse. tinel
communica to chi jud Paacutieity,nt re, post atricxpecte
une while ica Sul g deat
for
ditati on hcomm
im
ntin eveel nt
11, p 2 Furt
elandher,
eve res in sen not
ision it bas ed onenters
a psy tout futu
.110
abo a psy
chi ide,
isrd suic . cho
talpsy
log invo
Hospital cetheaccre
d
neelvin senel
nti
ledSE,
ther eof. is,
gation
all sen
that tin resultr are
an
erro e 2014 W 131
al dec adm oth entienty,
pati t saftoetyrega hospi or rge. occurren are ascal anseate
mrisk invt esti signuralbecaus
al
ors
nic
isioisn pri
toma rily hiat jud orgm
ric ion ischa
atriicc pect
, postd ed nts
ient, the
ter
Thoreimm s; no physi
s tuse me
all dic
cal
err
they March
he cli edtoon
a psyc selft abou iss
acui
tPat atr ients every,
inpat
anl hinju ediouseriou and nts occ . 59, Nol 3,

T T
futurechi unex onym or no
beca
ical spi dectal
to adm yit bas ersfor toadm
t.110 is dchisuicid
a psy while
l.e,patholo
Suc
gica
will invol d for
neeving
death tine lnt
and
eve11, l eve
p 2 Furth er,
resp onse Vol tine
he clin
decision ho
is prim
arildan
dtoon
psych
ger
judg
iatric patien
oramen non issi
oth
enton ,safe
era l or
to ty
regar hos
c ion orthepsyc
,pita ientrencethe
syn
calle
se
sen
dthere
ntin
an
elof.
err or, tineand
sention chia
Psyult
try,sen
are not
rin
use h 2014 W
aand self occur stiga
ty,t base ,tsorare l lofres
qu acuity termrisk inveall 131
clinical to ladmi e rs. 110 Pati
about adm a genpsyc iss
ric
atri ectedienpatts thatThe the of te
us; notandadia
rssignaerro l

T T
pita hiat even rna
dica
he
al decis ion
hosprim
ital is sev
arily
eridan
on
ger
judgm
uis ite sin
or othe ent
noneth for
er in to
l orah psy
nsafety an chi
is adm unexp t the
thapat
thepsych ologi caland
Suc
sellf, need
hinjury
for immmo edia
t not se
becau
me
all erro
Jou
nthey r beca Marc
he clinichosp and
y,based self ntera eital. o thesynony ts occu No 3,

de revuespour tous vos besoins de tirs part,

toreq qua t wil nel
l even
r, and nse.
primaeritrily
aerpre sine un 110wh
it, adm
s.for a issio
Patie gen g suc ric
issi
ass umor
on,
hosp the
stoien event thees int senti
tine The Can
inelandeven respo Vol 59,
inel
hospital isrity, sev
and danguis
self
toreq qua
ite
or other
non
ent
ati wheth er inpo
to rtin
ora psych
psyc
an admiatric
hiat
sly
res ethe t
pati ent
the
har pat
m e tim
tha t aretermcalled
sen
of an erro
invesall sent
tigati on
Psyc in
hiatr
lt are
y,sent
not
seve a rpre sineinp ssion supral h thaing Such abl Theimmediate
, and ous; notand all rsofresu
error
and dange s exp because h 2014 W
fort, admi a in
gene suc n, lud tal. son
self Jourical
n erro
nal 131
severity, a prer equisite
qua
atie nt uni
non therarl iny,por ting
or psych
nd
frieres iatric
admsly
hospi
issio um
m, inc
ass patitoentthe will
e rea the needthe
e into
for
synonym event
r, and
notadia med
quisit e sine inp
unit , whe Cle
in supal
gener and
such an har the
har
patien form
tssom e tim
that senti nel
erro The Canel events occur 59, No 3, Marc
a prere inpatien t , a
in ortingilynds ssion exp m, the that
ing abl The term of an all sentin ofresult Vol el
Cleersupp
arly fro me exttoend
lud sonand in sentin
iatry,
unit, wheth
inpatient Clearly, in
faman
andexpr
ilysuch
admi
frieessltec y assu
ted m,n inc
wi ll patien the self,
will
et rea the ymous; not all errors al Psych
suppo rting
fam frien ds beassumpro
fro m ehar that gthe
tioend
udin for som
harm le time into synon error, and
that not dian Journ
Cana W 131
in ted tec
incll ext the and
onab of an The 2014
Clearly, family and protec
expre
s be sslyharm
thi s ,pro
wil to e reas self,
try, Vol 59,
No 3, March
friend d from tionnd
tecding harmfor som time into
the
family andbe prot

crivez ladresse CJP@cpa-apc.org.

ecte , inclu l of Psychia
thisnpro
harm
from ectio will exte JP.canable
reaso The Canadi
an Journa
be protected
this prot d for some w.TheC
ction will exten CJPww .ca
this prote www.The
www. TheCJP.ca
a
www.TheCJP.c

www.LaRCP.ca
Veuillez citer la rfrence au complet, y compris le titre de larticle, la date du numro, et les numros de page,
ainsi que les quantits dsires.

www.TheCJP.ca The Canadian Journal of Psychiatry, Vol 59, No 3, March 2014 W 147