SUICIDE - THE INTERACTION OF CLINICAL AND ETHICAL ISSUES

Although bioethical principles such as beneficence, nonmaleficence, an d autonomy increasingly guide clinical decision making, in good clinic al practice none of these principles is absolute. The authors describe how clinical and ethical issues interact in prioritizing principles i n the treatment of suicidal patients. For the acutely suicidal patient , beneficence mast be given primacy, as it should for the chronically suicidal patient who is unable to control self-destructive impulses. H owever, 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 rig id, application of ethical principles,