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[The psychiatrist as gatekeeper in requests for assisted suicide: a qualitative study].

In Switzerland, psychiatrists sometimes assume the role of gatekeepers when patients request assisted suicide, evaluating the patient's discernment and the existence of a possible psychiatric disorder interfering with the capacity to discern. Our study explores the motifs of requests for assisted suicide made by patients hospitalized in a somatic service of Lausanne University Hospital and the challenges faced by the psychiatrist as gatekeeper. We conducted a retrospective analysis of psychiatric reports concerning 18 patients aged 65 years or older who had requested assisted suicide. We aimed to identify both manifest and latent motifs in the patients' accounts, referring to the attachment theory and a psychodynamic analysis based on the concepts of the Ideal ego, the Ego ideal and the Superego. Different categories of motifs for assisted suicide requests were expressed by the patients. We also found indications of insecure and secure attachment, and underlying feelings of shame and abandonment, more rarely of guilt. In addition to limitations related to the patient's condition, the gatekeeper position limits the possibilities of addressing these issues or using them therapeutically with the patient. The psychiatrist' role as a gatekeeper in assisted suicide is uncomfortable. He or she must think about how to assume this role while remaining being a liaison psychiatrist.