Allowing suicide vs. not allowing suicide????

[PMHNP10]

I ask this question because it has been buggin' me to no end. I'm thinking I know the answer, but maybe I need to hear it from someone else to set off the lightbulb

OK, so here goes: If an individual says they want to kill themselves we do everything we can to prevent it, including, but not limited to an involuntary admission to an inpatient psych unit.

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?

[pattycakeRN]

Aside from the law: I have no business telling someone they have to live. If you want to kill yourself, you (should) have every right. Who are you to say that person wants to go for treatment? Do you even know how painful that can be? If it ever works? No to mention the fact that it's different for every individual, so don't come back with, "I was depressed and suicidal, and I'm fine now!" stories.

Basically, you don't know what's in my head or anyone else's. 'Saving' someone just to make yourself feel better is incredibly selfish.

[canoehead, BSN, RN]

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

But we should be treating with the best interests of the PATIENT in mind, not family.

I believe that a person that has truly made a decision to end their life will not seek help, or tell people that might stop them.

[PMHNP10]

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.

I was aware of the situation you mention. I think the hospitals I've worked in call it an ethics committee or something along those lines. However, my experience is that this committee is called in when a patient is already inpatient and wants to leave AMA; does this process function in busy ERs?

[PMHNP10]

Presumably, if a person is coming to the ED with intent to commit suicide, this is seen as a cry for help.

In general I agree with the above statement.

People who REALLY intend on ending in all will do just that, and not end up in an ED to begin with.

I'm not so sure I totally agree here. I've run into quite a few folks who really really had a lethal plan and were just about to execute their plan and got caught through no lack of their effort isolate themselves.

[Tweety, BSN, RN]

Very excellent topic.

If a patient is refusing treatment as a means of suicide, then you probably can stop them from refusing, but it's a lot of drama. Recently we had a patient refuse a surgery and as a result he's now crippled for life. After he refused, which was completely totally illogical, we got a pysch consult to see if he was competent to make this decision. Pysch. deemed the patient competent and there was nothing we could do but send him to a nursing home with his pelvis and leg broken, legs all malformed for bedrest for six weeks until docs can clear him for physical therapy.

[jessiern, BSN, RN]

Would you all agree at the very least, we should first evaluate the patients to ensure they are not suffering from a mental disorder (depression included). I just can't see turning a deaf ear to a suicide attempt when the patient may be suffering from a disorder that can be treated. Someone that attempts suicide see no other way out, but they are so close to the situtation. Others may be able to see what they can't, and offer hope. Just my two cents, and maybe I'm too idealistic. Sorry

[Tweety, BSN, RN]

Aside from the law: I have no business telling someone they have to live. If you want to kill yourself, you (should) have every right. Who are you to say that person wants to go for treatment? Do you even know how painful that can be? If it ever works? No to mention the fact that it's different for every individual, so don't come back with, "I was depressed and suicidal, and I'm fine now!" stories.

Basically, you don't know what's in my head or anyone else's. 'Saving' someone just to make yourself feel better is incredibly selfish.

I'm not 100% sure I support you here. You did say "aside from the law..." which means the law is on our side and states we must take reasonable steps to stop someone from killing themselves. So "saving" someone might not just be an act to make ourselves feel better, it's just the right thing to do, in most cases...in fact the law trumps any personal opinions I might have.

What I do support is somone's right to refuse treatment, even life saving treatment. You indeed do not know what's going on in someone's head. They might want to live out their remaining days the way they choose rather than spending endless hours in the hospital, or going from doctor to doctor, getting sicker and sicker from a treatment that might now work.

I recently lost an acquaintence (not a real good friend, but someone I saw occasionally through other friends) whom upon learning he had AIDS four years ago refused to go on any drug therapies, depsite the fact that they are working for many people, and we both knew many HIV positive people living healthy and happy lives. He died of complications from his illness his way. I was unable to go to his service because I covered for someone who was closer to him, but I heard he orchestrated the entire thing and did it his way. Who am I to judge him for not taking treatment?

[Tweety, BSN, RN]

Would you all agree at the very least, we should first evaluate the patients to ensure they are not suffering from a mental disorder (depression included). I just can't see turning a deaf ear to a suicide attempt when the patient may be suffering from a disorder that can be treated. Someone that attempts suicide see no other way out, but they are so close to the situtation. Others may be able to see what they can't, and offer hope. Just my two cents, and maybe I'm too idealistic. Sorry

I 100% agree with you. Reasonable steps should be taken to prevent a person from kiling themselves intentially.

[PMHNP10]

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

You see, I would contend that a morbidly depressed individual experiences as much mental pain as a terminally ill patient might experience physical pain. Some of these folks are living in a perpetual hell.

In spite of the fact that I've spoken with many of these folks who's mind tortures them daily for years, I can't even begin to imagine the suffering they endure every waking moment of their life.

But this is what is so fascinating with mental health...these patients suffer and often the families naturally suffer as well. So if a patient ends their life to end their suffering, in the long run, does this really affect the family any different than it would if a patient loses a long battle with a terminal illness?

I'd be willing to bet that most families would verbalize that there is a difference in dealing with a terminal illness death vs. a suicide death; I suspect families would say a death from a terminal illness is less painful over time than a death from a suicide, possibly because a family of a suicide victim would go through a process of blaming themselves for the patients suicide, although such thinking is most assuredly not the case; I'd contend that if there were an objective way of measuring grief there wouldn't be a difference.

[PMHNP10]

Would you all agree at the very least, we should first evaluate the patients to ensure they are not suffering from a mental disorder (depression included). I just can't see turning a deaf ear to a suicide attempt when the patient may be suffering from a disorder that can be treated. Someone that attempts suicide see no other way out, but they are so close to the situtation. Others may be able to see what they can't, and offer hope. Just my two cents, and maybe I'm too idealistic. Sorry

absolutely I believe our system should attempt to help these folks as we do cancer patients, cardio patients, resp. patients, etc., but I acknowledge that there is a time when the treatment is not working and maybe it's in the patient's best interest to let them go just as we would one of the medical patients above

[PMHNP10]

thank you everyone for your excellent responses; it's certainly a fascinating topic

[Tweety, BSN, RN]

...................and maybe it's in the patient's best interest to let them go just as we would one of the medical patients above

Who is going to make that decision? A doctor? A court of law? An ethics committee? Some would say it's playing God.

I understand what you're saying. If someone has been suffering mental anquish for many years, or a lifetime, not responding to treatment, what's the point in that kind of suffering. From someone who knows first hand, mental anguish is as bad, if not worse than physical pain.