When Should A Physician Help A Patient Die?
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*
I would try to save her because I couldn’t assess her competency. I might also suggest that attempted suicide (in a healthy young person) buys them an automatic “incompetent to make medical decisions.” Depression does not make someone incompetent to make medical decisions - unless those decisions are suicide/homicide. Then the person is more than depressed, they’re a potential threat to self/others and thus their wishes should be overruled.
I spend a lot of time caring for suicidal patients. Most of them aren’t entirely serious, but we take them seriously. I can’t imagine looking at them and saying, ‘fine, go forth and die!’ Because most of them arrived because they told someone they were suicidal, or a loved one called EMS or police, or because they, themselves, called for help.
When this becomes a stick wicket, we’re slipping towards trouble. Depression and life circumstances may lead one towards suicidality. But if we consider that normative, then we should simply dispense with antidepressants and commitments. We should just accept that some will kill themselves, and assume that it is always a rational, well-considered decision. It sure will make my life easier! But…
What if it’s my son or daughter? My wife or father? Do I simply say, ‘well, they’re tired of it all?’ Should I accept that a physician elected not to intervene, out of respect for the wishes of my suicidal child, who needed therapy and hope more than antifreeze?
I guess the question is one of fundamental worth. As we gradually move towards an ethic that considers human health-care an economic burden on money otherwise used for meaningful progress or entertainment; as long as we consider humans an environmental hazard and plague on the planet; as long as we think of humans as having no intrinsic value, then we can just start letting them die at will.
But if so, let’s inaugurate a new profession: thanatology, or mortology, a profession whose work is death. Day in, day out providing the death so desired by the rational masses. Just don’t as me to do it.
I have a hard enough time with saving lives.
Edwin