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 decisionsuninfluenced by any mental disorder-there 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 one's 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. W W W Suicide : rationalité et responsabilité de la vieObjectifs : La mort par suicide est généralement vue comme un résultat indésirable. La plupart des pays occidentaux mettent l'emphase sur l'autonomie du patient, un concept controversé relativement au suicide. Cet article explore les tensions entre les droits des patients et le désir ardent de nombreuses sociétés de prévenir le suicide, tout en clarifiant les relations entre les troubles mentaux, la capacité mentale, et le suicide rationnel.Méthodes : Une recherche de la littérature a été menée à l'aide des mots clés suicide et éthique, dans les bases de données PubMed et LexisNexis Academic. Les titres et résumés d'articles ont été étudiés et jugés pertinents si l'article abordait les sujets du suicide rationnel, de l'autonomie ou des droits des patients, ou de la responsabilité de la vie. D'autres articles ont été repérés dans des bibliographies et par des suggestions des réviseurs préliminaires du présent article. Résultats :Le comportement suicidaire d'une personne ne peut pas être assurément prédit et pourtant, diverses associations et organisations ont mis au point des normes de soins pour prendre en charge les patients présentant un comportement suicidaire. La responsabilité de prévenir le suicide tend à être imposée au clinicien traitant. Dans les cas où une personne est capable ...
Objective Psychiatric disorders and their treatments have the potential to adversely impact driving skills. However, it is unclear to what extent this poses a public health risk by increasing the risk of motor vehicle crashes (MVCs). The aim of this systematic review was to synthesize and critically appraise evidence on the risk of MVC for drivers with psychiatric disorders. Method We conducted a systematic review of the MVC risk associated with psychiatric disorders using seven databases in November 2019. Two reviewers examined each study and extracted data. The National Heart, Lung, and Blood Institute Quality Assessment tools were used to assess each study’s quality of evidence. Results We identified 24 studies that met the inclusion criteria, including eight cohort, 10 case-control, and six cross-sectional designs. Quality assessment ratings were “Good” for four studies, “Fair” for 10, and “Poor” for 10. Self-report or questionnaires were used in place of objective measures of either MVC, psychiatric disorder, or both in 12 studies, and only seven adjusted for driving exposure. Fifteen studies reported an increased risk of MVC associated with psychiatric disorders, and nine did not. There was no category of disorder that was consistently associated with increased MVC risk. Conclusion The available evidence is mixed, not of high quality, and does not support a blanket restriction on drivers with psychiatric disorder. An individualized approach, as recommended by international guidelines, should continue. Further research should include objective assessments of psychiatric disorders and MVC risk and adjust for driving exposure.
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