In recent weeks, many French psychiatrists and psychologists have expressed the concern that assisted suicide and euthanasia may be made available to patients suffering from psychiatric illness or psychopathological disorders. This has resulted in a paradigm shift from "we must do everything to save the patient's life" to "in some cases, we must accompany the patient if he or she chooses to die". These new provisions which are developing on our borders are part of a broader system concerning the end of life in general where psychiatry and clinical psychology, regardless of their specificities, find themselves on the same level as physical well-being. We review the evolution of ideas concerning suicide as an historical, anthropological, sociological and increasingly media -related fact. . . at the risk of the spread of suicides. We then clarify the differences between the non -pathological suicidal suffering inherent in human existence, and the suicidal suffering that constitutes a symptom or a pathological process. Between these two extremes that some may regard as self-evident, there are a multitude of complex clinical situations. Let us think of the patient suffering from schizophrenia who, in his hallucinations, hears a voice urging him to die, whereas, a few weeks later, after undergoing appropriate treatment, the hallucinations have subsided. Let us consider the patient presenting with a bipolar disorder who, in a depressive phase, no longer sees any point in living, whereas, a few months later, under treatment or more simply following the spontaneous evolution of his disorder, he is in great shape during a hypomanic phase. But there are also those who suffer from schizophrenia or bipolar disorders that are resistant to treatment, which leads to chronicity with a high rate of suicide (not associated with any "medical aid in dying"). We describe the phenomenon of suicidal ideation and behavior as a continuum at risk of breaking down, and we then consider the example of people with post-traumatic disorders. While psychic trauma results from a confrontation with death, rather than subsequently distancing oneself from it, the psychically impaired subject will often remain monopolized, overwhelmed by this repetition of death, sometimes to the point of wanting to become one with it through suicidal behavior by acting out a final flashback. We must therefore ensure that "medical assistance in dying" does not become an extension of the symptom, a symptom reiterated by society. Lastly, we address the form that a medico-psychological expertise commission might take in the context of a request for "medical assistance in dying" by proposing a list of questions put to the expert.(c) 2023 Elsevier Masson SAS. All rights reserved.
