Although bioethical principles such as beneficence, nonmaleficence, and
autonomy increasingly guide clinical decision making, in good clinical
practice none of these principles is absolute. The authors describe how
clinical and ethical issues interact in prioritizing principles in the
treatment of suicidal patients. For the acutely suicidal patient,
beneficence must be given primacy, as it should for the chronically
suicidal patient who is unable to control self-destructive impulses.
However, 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 rigid,
application of ethical principles.