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?

[PMHNP10]

after a while, perhaps the patient is in the best position to make their decision about their life?

and just as a dr., committee, or court discontinuing treatment could be considered God, so could the forced continuation of treatment in spite of of little/no success

[jessiern, BSN, RN]

after a while, perhaps the patient is in the best position to make their decision about their life?

Not to be a PIA, but that is in my mind circular logical. Treatment is started when the patient desires to end life. So then, at what point is it now okay for that patient to again make that decision. Who decides when that patient is at an acceptable point to make that decision. Would it be a standard amount of treatment time, say X months of failed treatment, then patient my pull trigger, or would it be different depending on the patient. And what about a patient under the age of 18, since I high percent of suicide attempts are adolescents?

[Tweety, BSN, RN]

after a while, perhaps the patient is in the best position to make their decision about their life?

and just as a dr., committee, or court discontinuing treatment could be considered God, so could the forced continuation of treatment in spite of of little/no success

Which is why such decisions are under the realm of "ethical delimma's". :)

I think a person in sound mind certainly can make the choice to end their life and perhaps we should respect that.

But the person in the throes of a suicidal situational depression needs to be protected from themselves.

It's tough and I hate to sound wishy washy, but there are too many variables for me to come up with a blanket policy that I would suport.

[jessiern, BSN, RN]

Which is why such decisions are under the realm of "ethical delimma's". :)

I think a person in sound mind certainly can make the choice to end their life and perhaps we should respect that.

But the person in the throes of a suicidal situational depression needs to be protected from themselves.

It's tough and I hate to sound wishy washy, but there are too many variables for me to come up with a blanket policy that I would suport.

And that is why as healthcare professionals we do not allow patients to commit suicide. Too many variables, eithical issues, slippery slopes, and so forth and so on and various things of that nature.

[dortizjr1]

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?

I work in a busy ED and we don't call an ethics committee. I have patients routinely leave the ED AMA or at least sign a voluntary limiting of treatment agreement. This past week I had several people go through entire cardiac workups to reveal life threatening conditions and in the end each one left AMA.

I wondered about a persons right to die. Well i guess it isn't a right to die is it? A person can drink themselves into oblivion, shoot heroin, smoke crack, or do what ever drug of choice and destroy themselves and slowly destroy every one attached to them and they come into the ED via ambulance when they've been found by a loved one. Then once they are sober, or out of the influence they can simple insist to the Behavioral health people that they aren't trying to kill themselves and that is the end of the story. They walk out.

I had a young person being brought into the ED frequently for OD'ing. I tried to 302 this person but the county crisis person denied my petition because he felt there wasn't sufficient evidence for it. I coiuldn't get the physician to back it up either. However. I 302'd a person last week because she said she wanted to kill herself while she was being triaged and that involuntary commitment passed with no problem.

so I'm left with... ??? ...

[PMHNP10]

I work in a busy ED and we don't call an ethics committee. I have patients routinely leave the ED AMA or at least sign a voluntary limiting of treatment agreement. This past week I had several people go through entire cardiac workups to reveal life threatening conditions and in the end each one left AMA.

I wondered about a persons right to die. Well i guess it isn't a right to die is it? A person can drink themselves into oblivion, shoot heroin, smoke crack, or do what ever drug of choice and destroy themselves and slowly destroy every one attached to them and they come into the ED via ambulance when they've been found by a loved one. Then once they are sober, or out of the influence they can simple insist to the Behavioral health people that they aren't trying to kill themselves and that is the end of the story. They walk out.

I had a young person being brought into the ED frequently for OD'ing. I tried to 302 this person but the county crisis person denied my petition because he felt there wasn't sufficient evidence for it. I coiuldn't get the physician to back it up either. However. I 302'd a person last week because she said she wanted to kill herself while she was being triaged and that involuntary commitment passed with no problem.

so I'm left with... ??? ...

I assume 302 is starting the involuntary inpatient admission process?

OT: You present an interesting case...on the one hand, it doesn't sound like the person is imminently suicidal because this has occurred multiple times; but obviously I couldn't be certain without talking to the pt. OTOH, would I want to risk my license on the hope that the patient doesn't accidently (or purposefully) succeed in the future?

So back to my topic...so if I'm brought into your ER with an evident MI (per workup) or appendix about to burst, and if they want to leave (which could mean the MI patient could drop in your waiting room or parking lot), they can do just that without having to undergo a psych eval? But if I'm brought into your ER by police post suicide attempt, I'm stuck until I'm no longer suicidal, or until the extent that the local court can hold me involuntarily.

[Tweety, BSN, RN]

So back to my topic...so if I'm brought into your ER with an evident MI (per workup) or appendix about to burst, and if they want to leave (which could mean the MI patient could drop in your waiting room or parking lot), they can do just that without having to undergo a psych eval? But if I'm brought into your ER by police post suicide attempt, I'm stuck until I'm no longer suicidal, or until the extent that the local court can hold me involuntarily.

If there is any suspicion that you might not be competent to make a decision, then you won't be able to just walk out of the ER post MI or burst appendix. A psych eval might be perfectly in order. An MD here in Florida can commmit you involuntarily if they think there's a pysch issue involved even if you only presented to be treated for physical/medical symptoms. I've seen it happen more than once, although it's not common.

I've seen many patient refuse part of their treatment, they'll take pain medicine but won't undergo an x-ray. They refuse to be stuck for an IV, but will undergo tests. They'll accept outpatient treatment, but won't be admitted. Stuff like that is common. You want to scream "what did you come to the ER for in the first place if you're going to refuse treatment!"

[EricJRN, MSN, RN]

If anyone is looking to research the 'allowing suicide' issue further, Thomas Szasz is a name to look up. I can't wholly agree with his stance, but he certainly presents an alternative to the traditional views of crisis intervention.