Suicide: the interaction of clinical and ethical issues

Although bioethical principles such as beneficence, nonmaleficence, and autonomy increasingly guide clinical decision making, in good clinical practice none of these principles is absolute. The authors describe how clinical and ethical issues interact in prioritizing principles in the treatment of suicidal patients. For the acutely suicidal patient, beneficence must be given primacy, as it should for the chronically suicidal patient who is unable to control self-destructive impulses. However, some chronically suicidal patients may be capable of resisting these impulses, and in such situations, respecting patients' autonomy facilitates clinical work and prevents the therapist from being drawn into a role that encourages regression. The successful management of the suicidal patient illustrates the need for dynamic, rather than rigid, application of ethical principles.