Differentiating suicide from life-ending acts and end-of-life decisions: A model based on chronic kidney disease and dialysis

Background: Technological advances continue to yield life-prolonging treatments that complicate the occurrence of death. Until recently, refusal to submit to recommended care was considered suicide. Objective: Physicians must now decide how to respond to requests for hastened dying. Method: The authors propose a four-square grid distinguishing true suicide from behaviors such as treatment termination and lethal noncompliance. Results: One axis characterizes whether actions hasten death. The other identifies how the patient's social and medical network collaborate in the decision-making process. Conclusion: Using chronic kidney disease to model intent and collaboration, treatment is framed within a paradigm that reflects both end-of-life decision-making complexities and contemporary conceptualizations of suicide.