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Post Autonomy of suicidal patients
Author: Jkhan
Date: May 12, 2010 10:20 pm
An elderly patient comes to the ED with drug overdose in an attempt to take her life. She is accompanied by her family who state the patient has a living will. She ends up getting intubated but later family wishes for her to be withdrawn from the ventilator based on patient's wishes to die and not be treated with life support. Should this patient be liberated from life support? She has no major medical problems (besides life long history of severe refractory depression and previous suicideal attempts) and she is expected to make a complete recovery within 2-3 days once the affect of drugs wears off. Thank you.
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Re:Autonomy of suicidal patients (by DharmaDoc on 05/13/2010)
The short answer is "No". 1. People who attempt suicide because they are depressed lack capacity to make rational decisions. If you see someone about to jump off a bridge, you try to prevent them from doing it.
2. When someone presents to the ED, they are seeking treatment. It isn't clear why she was intubated, but someone had to consent to intubation - further evidence of a desire to be treated. 3. Living Wills are meant to apply when someone is in a life-threatening irreversible condition, not a temporary condition. (They don't, for example, apply during surgery.) 4. If you have an Ethics Committee, it might be helpful to involve them in this case.
Re:Autonomy of suicidal patients (by SharolHerr on 05/14/2010)
This is an ideal case to engage your system ethicist or obtain a consult from the ethics committee. It would also be appropriate to have a psychiatric evaluation. MSW would also be ideal to facilitate guardianship if that would be needed. It isn't possible to render a clinical decision about this case in the forum format but I would encourage you to convene the interdisciplinary team, ethics and physicians in deliberation about this case. Sharol Herr, RN, BSN, MSEd, CHPN; Nurse Clinician/Education Coordinator; Mount Carmel Health Palliative Care Leadership Center; Columbus, Ohio.
Re:Autonomy of suicidal patients (by TerrellVanAkenMD on 05/04/2012)
I know this original post is from some time ago but we just experienced a similar situation in our ER and I was wondering about everyones further thoughts. Our patient was 58y.o. and brought in as a 5150 (involuntary hold) with a drug ingestion. Hx of depression. Her respiratory status worsened and the family asked that we not intubate as she has a POLST that stipulates DNR and DNI. I confirmed with the Calif. Coalition for Compassionate Care (that championed POLST in Calif.) that POLST is null and void in the setting of suicide and I recommended intubation for this reason and the same reasons cited in the original post comments: i.e. lack of capacity in this setting. There was not time for an emergent bioethics meeting ( though we will have one soon) so the VPMA called legal and the attorney felt that as long as the family was aware of the potential for death that it was OK not to intubate. I was very uncomfortable with that recommendation not only ethically but also legally as it feels almost as if we are assisting in her suicide.
The patient was not intubated though put on BIPAP and barely snuck through and survived. She then felt embarrassed and foolish with the attempt which makes me even more nervous about the decision not to intubate though we got away with it.
Are there not legal questions here too as well as the ethical ones with a patient with depression and attempted suicide????

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