Am J Psychiatry 1990; 147:488-491
Copyright © 1990 by American Psychiatric Association
Paradoxical patient reactions to psychiatric life support: clinical and ethical considerations
SL Pauker and AM Cooper
Payne Whitney Clinic, New York Hospital, NY.
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support was withdrawn.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.
