Allowing suicide vs. not allowing suicide????

jessiern, BSN, RN · Mar 17, 2008

OTOH, if a patient comes in to the ER with a medical complaint and it's discovered that the pt. has an acute situation where refusing medical care would most assuredly result in the pt's untimely demise, don't we allow them to sign out AMA (although I suspect such a scenario seldom occurs)? Am I not correct? If I am correct, I can't help but wonder why our healthcare system allows this to happen?

Because patients have the right to refuse treatment...even if it is not in there best interest. They can only be held if they are a danger to themselves or others.

The best example I can think of to show the problem with not allowing patients to refuse treatment is a Jehovah's Witness. In their belief's, it is a sin to recieve a blood transfusion. While that may seem silly to others, they strongly believe that. For them, it is a sin, even if refusing leads to death. And if they believe that strongly, I don't feel I am morally the person to force them into it.

caroladybelle, BSN, RN · Mar 17, 2008

Just as we continue to allow people to smoke/use Tobacco and it continues to be legal.

Looking all of the evidence, why do people continue to smoke....unless they desire to die and early, painful death or be disabled?

nightmare, RN · Mar 17, 2008

Well basically because nicotine is probably more addictive than heroin!

PMHNP10 · Mar 17, 2008

Because patients have the right to refuse treatment...even if it is not in there best interest. They can only be held if they are a danger to themselves or others.
The best example I can think of to show the problem with not allowing patients to refuse treatment is a Jehovah's Witness. In their belief's, it is a sin to recieve a blood transfusion. While that may seem silly to others, they strongly believe that. For them, it is a sin, even if refusing leads to death. And if they believe that strongly, I don't feel I am morally the person to force them into it.

that was the example that was coming to mind for me to, so why can't a severely depressed person with no hope for the future refuse treatment

not only do we not allow these folks to refuse treatment, but if the refusal goes on long enough we go through the court system to force them to comply with treatment (specifically meds)...so I wonder what the distinction is

is it really something so simple as the actual verbalization of intent w/a plan for suicide that makes forced treatment justifiable? or is there something more complex at work here (e.g., 2 separate rulings in 2 separate courts; one dealing with medical; one dealing with psych)?

PMHNP10 · Mar 17, 2008

Just as we continue to allow people to smoke/use Tobacco and it continues to be legal.
Looking all of the evidence, why do people continue to smoke....unless they desire to die and early, painful death or be disabled?

right, we have the right to destroy our lungs which could result a long agonizing death; we have the right to walk out of an ER with rebound RLQ ab pain, but if we want to put a gun in our mouth and pull the trigger, after losing our family our job and our home we not only can't, we are going to be treated into submission until the meds change our mind

and so noone thinks otherwise, I'm not necessarily advocating we allow anyone to off themselves on a whim, but I don't necessarily agree with this apparent double standard either

btw...IMHO, our govt. allows folks to smoke because it brings in $$$$--from taxes as well as the big tobacco lobbyists, so how could we possibly turn down the cash?

elkpark · Mar 17, 2008

At every place I've ever worked (in the nearly 25 years I've been in nursing), when someone wants to refuse life-saving medical treatment (in medical-surgical settings, not psych -- e.g., when someone decides they want to discontinue kidney dialysis), the medical treatment team orders a psych evaluation to get an opinion about whether or not a) the person can be considered (mentally) competent to make that decision and b) the person may be suffering from treatable depression that would influence their decisions, in order to be able to make a decision about whether to pursue involuntary commitment and forced treatment.

Most hospitals, if only to protect their own collective butt, would not just discharge AMA someone with a medical condition that, untreated, would result in her/his death without going through a lengthy process of evaluation, waivers of responsibilty, possible legal action, etc. I don't mean just something that should be treated, but something that would be expected to produce the person's death.

However, in terms of your original question, I have often pondered that, too -- given that we live in a society that claims to value free will and self-determination over nearly anything else, how come we refuse to allow people to make the most basic and fundamental decision of all -- whether to live or die??

deeDawntee, RN · Mar 17, 2008

Presumably, if a person is coming to the ED with intent to commit suicide, this is seen as a cry for help. People who REALLY intend on ending in all will do just that, and not end up in an ED to begin with. Also, often if depression can be treated, people will find their own way out of their circumstances and suicidal intentions. Personally, I agree that we should hold these people and help with crisis intervention, so that a misintended suicide attempt doesn't actually kill them.

Jarnaes · Mar 17, 2008

Theoretically, I don't see why a competent individual should not be allowed to commit suicide. If you have made the decision to end your life, you should have the right to do so.

The problem is in all the confounding variables that overwhelms this issue. So I don't think we'll ever see the day when this is allowed.

beender · Mar 18, 2008

Very sticky wicketts we find ourselves in from time to time especially with patient's rights issues! IE: your patient is a quad, vent dependant, and has a feeding tube. Otherwise NPO. He is given good oral care, and has adequate hydration. He has "signed" a waiver, acknowledging risks and can recite them. Some nsg staff are leary of the potential consequences of giving fluids. (licensure, disciplinary actions, lawsuits) The social worker tells us that there are just as many issues associated with NOT bringing him the fluids.

How legal is a waiver? Wouldn't there have to be a "reasonably prudent nurse's" standard to follow? He wants to go ama and can't do so without assistance - and one further question to ponder - is this the first step on a proverbial "slippery slope"? This will be going before our ethics committee - hmmmmm.:thnkg:

CHATSDALE · Mar 18, 2008

old saying 'sucide is a permanent solution to a temporary problem'

i would agree that a terminally ill patient in constant pain should be allowed [assisted?] to take control of their own demise

to a otherwise healthy patient in the thros of depression i believe that intervention would spare family and friends and ultimately achieve the gratefulness of the patient

Xbox Live Addict · Mar 18, 2008

old saying 'sucide is a permanent solution to a temporary problem'
i would agree that a terminally ill patient in constant pain should be allowed [assisted?] to take control of their own demise
to a otherwise healthy patient in the thros of depression i believe that intervention would spare family and friends and ultimately achieve the gratefulness of the patient

:yeahthat:

Plus, a health care professionals are required by law, at least in my jurisdiction to arrange hospitalization for any patients they feel are a danger to themselves or others. The patient is given the opportunity to voluntarily hospitalize themselves (and avoid a judicial hearing), but if not, the legal system steps in.