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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0943

Risk, decision-making capacity, and compulsory treatment: an ethical challenge in suicide management

RISK, CAPACITY, INVOLUNTARY TREATMENT : ETHICAL CHALLENGE IN MANAGING SUICIDALITY

Managing high suicide risk in an older patient with preserved decision-making capacity and no severe mental illness starkly highlights the ethical tension between beneficence and respect for autonomy.

The aim of this case report is to discuss the tension between compulsory treatment and respect for patients’ fundamental rights through the management of suicide risk in an older adult; the authors note that these ethical issues have been insufficiently examined in psychiatry and that the difficulty arises from conflicts among the principles of beneficence, non-maleficence, and autonomy. Suicidal behavior in older adults is shaped by the combined effects of physical illness, functional decline, psychosocial stressors, and cognitive vulnerability, while the limited availability of risk-reduction strategies for this population compounds the challenge. The case concerns an 86-year-old woman whose first contact with mental health services occurred in February 2025 following emergency presentations for reduced oral intake and weight loss, and whose mood deteriorated following a serious conflict with her adult daughter, after which she described thoughts of ending her life; during assessment by the home treatment team, she expressed an intention to end her life in April, a month associated with the loss of several loved ones, disclosed that she had researched suicide methods and considered various means, including medication overdose, and was reported to have offered a clinician money to supply medication for this purpose, prompting an assessment under the Mental Health Act and subsequent hospital admission. The diagnosis was considered to be adjustment disorder with brief depressive reaction in the context of prolonged grief; apart from a possible overdose approximately 40 years earlier, no history of substance misuse, involvement with the criminal justice system, or previous psychiatric treatment was identified. Throughout admission, the patient engaged well with the multidisciplinary team, consistently denied depressive symptoms, and described her discussions of death as part of her philosophical and spiritual beliefs rather than an expression of active intent; psychological assessment identified risk factors including chronic grief, interpersonal conflict, deteriorating physical health, chronic pain, and age-related functional decline, alongside protective factors such as meaningful family relationships, strong social connections, personal values, spirituality, and a wish to remain in her long-standing family home, ultimately identifying a need for psychological support focused on grief and adjustment. Later in the admission, the patient reported that she no longer intended to act on her previous suicidal thoughts, and assessments by different professionals found no evidence of severe mental illness; nevertheless, clinicians remained concerned because of the recent specificity of her plans, her extensive research into methods, and ongoing psychosocial stressors, and the patient was discharged following a tribunal decision. The authors state that managing suicide risk in the absence of severe mental illness, but in the presence of multiple risk factors and preserved decision-making capacity, leaves clinicians facing considerable unease and uncertainty, and that a person-centered approach, capacity assessments, and multidisciplinary discussions may help alleviate this uncertainty.

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