Paradoxical patient reactions to psychiatric life support: clinical and ethical considerations

The authors describe cases illustrating two types of high-risk and especially difficult suicidal psychiatric inpatients. In the first case, a suicidal patient reacted to psychiatric life support measures (maximum observation) with increasingly life-threatening acting out, necessitating a difficult, seemingly paradoxical staff decision to withdraw life support. In the second, a patient felt to be improving killed herself when life support was withdrawn. The authors argue that there are clinical limits to psychiatric life support and an appropriate goal of psychiatric treatment is to maximize the chances for patient survival, rather than to attempt to guarantee such survival.