A Case of Attempted Suicide
One afternoon a nonambulatory,
morbidly obese, arthritic, and chronically depressed woman in her late
sixties who was in
chronic pain and addicted to drugs was brought to the ER. She had been injured
by an apparent self-inflicted gunshot wound. Her husband had called the paramedics
and she was brought to the ER. He said that had he known at the time he called
the paramedics that she had shot herself in the head, he would not have called.
She was taken to surgery and found to have sustained considerable damage
to her head but not much damage to the brain except to the frontal lobes.
The surgeons indicated that though the patient was intubated because of the
mechanical damage and edema in her neck, they felt she would be extubated
shortly. Because her brain damage was minimal and involved only the frontal
lobes, she was not expected to have neurologic motor or sensory deficit.
after her arrival at the ER, her husband brought a durable power of attorney
for health care (DPAHC) signed by the patient and dated approximately
three months earlier. The patient had designated the husband as her DPAHC
agent to make all necessary medical decisions for her should she become
unable to make them herself. He told the hospital doctors and staff that
his family were aware of the emotional and physical pain and suffering
the patient had had over the years and understood that she was depressed,
she wanted to end the suffering and he wanted them to stop the emergency
treatment and let her die. Some specific requests by the patient in the
DPAHC seemed to contradict the agent’s expression of her wishes, however.
For example, “If the extension of my life results in mere biologic
existence, devoid of cognitive function, I do not desire any form of life-maintaining
procedures. My agent should ask the question, ‘Is the proposed treatment
an aid to recovery or merely a prolongation of inevitable death?’ I
desire that my agent act after a reasonable time for observation and diagnosis.” Clearly,
if the proposed treatment were an aid to recovery, she desired such treatment.
The medical center’s lawyer
presented the staff with the current law, which essentially says that if
a patient enters a hospital as an
attempted suicide, the suicide attempt should not influence the interpretation
wishes expressed in the DPAHC. On this basis emergency treatment was
continued despite the emotional and persistent protests of the husband and
who wanted to let the patient die. Even after a two-to-three hour conversation
with members of the ethics committee, the husband was still insistent
on having the treatment removed.
The Ethics Committee
The committee suggested that the
above-quoted section of her recently signed DPAHC did not seem consistent
with the wishes of someone who
die. The husband responded by pointing out that her DPAHC was a standard
known to the patient for at least two years, written by an attorney
friend, but not signed until recently. He and the family emphasized to the
that this document did not represent her current desires and may not
have been fully read by her at the time of signing, and that she didn’t
want to live and suffer from her infirmities any longer. As her agent, he
stated he was expressing to the committee her real desires regardless of
what was stated on the form. The committee expressed to the family its concern
that it was obliged to follow the DPAHC because of ethical and legal considerations.
Since the patient was apparently beginning to recover, all the treatments
currently undertaken would be representing an “aid to recovery” and
not a “prolongation of inevitable death.” Further, there was
concern that the family was requesting the medical staff to “complete” the
failed attempted suicide.
Should the medical center follow
the agent’s wishes [sic] and
terminate all life-sustaining treatments and allow his wife to die?
Or should it
follow the expressed written terms of her directive and keep her
on the ventilator
until she could be weaned off of it?