Dr Tom Kerns
North Seattle Community College


A Case of Attempted Suicide


Consider this situation:

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.


Shortly 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 he and 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, but 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 law

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 of the wishes expressed in the DPAHC. On this basis emergency treatment was continued despite the emotional and persistent protests of the husband and the family, 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 wanted to die. The husband responded by pointing out that her DPAHC was a standard form 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 committee 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.

Discussion Question

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?