RT Journal Article SR Electronic T1 End-of-Life Mental Health Assessments for Older Aged, Medically Ill Persons With Expressed Desire to Die JF Journal of the American Academy of Psychiatry and the Law Online JO J Am Acad Psychiatry Law FD American Academy of Psychiatry and the Law SP 350 OP 361 VO 42 IS 3 A1 Linda E. Weinberger A1 Shoba Sreenivasan A1 Thomas Garrick YR 2014 UL http://jaapl.org/content/42/3/350.abstract AB In recent years, assisted suicide has been legalized in four states for those who are terminally ill and wish to end their lives with the assistance of lethal doses of medications prescribed by a physician. The ethics-related and legal questions raised by end-of-life suicide and decisional capacity to refuse treatment assessments are complex. In treating patients with end-stage medical conditions or disorders that severely affect the future quality of their lives, clinicians tend to engage in suicide prevention at all costs. Overriding the patient's expressed desire to die conflicts with another value, however, that of the individual's right to autonomy. We provide a framework for understanding these difficult decisions, by providing a review of the epidemiology of suicide in later life; reviewing findings from a unique dataset of suicides among the elderly obtained from the Los Angeles County Coroner's Office, as well as data from states with legalized assisted suicide; presenting a discussion of the two frameworks of suicidal ideation as a pathological versus an existential reaction; and giving a case example that highlights the dilemmas faced by clinicians addressing decisional capacity to refuse treatment in an elderly, medically ill patient who has expressed the wish to die.