Here’s an interesting case. A young woman drinks antifreeze to commit suicide, writes a note saying she does not want any medical treatment and calls an ambulance so she can die peacefully with the help of medical support.
I read a lot on Happy Hospitalist about a patient’s right to demand what ever care they feel is necessary to keep them alive and the duty of the physician to provide whatever care the patient feels they require, no matter how costly or how miniscule the benefit. Readers like to say it’s not a physician’s obligation to make quality of life decisions for the patient.
So let’s analyze this situation. Does a patient have the right to demand medical care and the services of physicians to let them die without pain? Does a patient have the right to demand a physician order morphine and ativan to keep a depressed but physically intact patient comfortable as they slip away in a horrible antifreeze death under the care of medical personel?
If you think the doctors should have saved her despite her competent wishes to deny life saving therapy, should all depressed patients be declared incompetent and have their rights to make their own medical decisions revoked?
Fascinating conflicts of interest here.
A physician blogger Alexy Inciarte, the doc who alerted me to this story gave me his thoughts:
I think DNR or do not treat often applies for terminal desease, yet in terminal desease you often go for paliative care, rather than doing nothing, but I guess this is a rare case, a young healthy woman with no terminal desease, that wrote a letter declining any treament, but with a possible underlying mental condition (reactive depresion due to the imposibility of having a baby). Normally the patient has the right to decline for treatment, but there are exceptions to this rule, when the patient is not mentally capable, there is a physiatric condition that blurs the judgment, I dont know but, I feel this is a different history…. How can you be sure she wasnt metally influenced by depression? If she was mentally influenced by drepession, not treating her, would be the right medical decision? even if she wrote a letter declining any treatment. If the doctors treated her, could be they sued? Could the doctors being sued by relatives for not treating her?
I wouldn’t try to save her, if I could verify her competency. And providing comfort is certainly within the role of the medical community. I would involve hospice services and transfer her to an out of hospital facility able to provide nonhospital services for end of life care.
What would you do as a nurse or doctor?
*This blog post was originally published at A Happy Hospitalist*