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May 6, 1998

The Role of the Psychiatrist in a Patient's Request to Die—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(17):1346. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-17-jbk0506

In Reply.—I agree with Dr King that psychiatrists may play multiple roles in the process of evaluating a patient's request to die. One of those roles may be in the management of appropriate analgesia or in the addition of adjunctive medication in the relief of pain such as antidepressants. He is also accurate in his description of the frustrating dilemma regarding those patients who do not receive adequate treatment for pain. Since pain is a subjective experience, there cannot be a separation between the physical and the psychological elements; however, the inclusion of a pain diagnosis in DSM-IV does not make all psychiatrists experts in pain control.