Human Exceptionalism

Should ER Docs Not Save All Suicide Patients?

This is what we are becoming. Five years ago in the UK, Kerry Wooltorton swallowed anti-freeze, called an ambulance, and then pinned a note to her shirt saying not to save her life. Accordingly, doctors let her die slowly over 24 hours–a decision later validated by the coroner’s inquest. 

Now, a discussion of medical ethics in a USA hospital saw some physicians advocating that ER docs not save the lives of suicide-attempt patients if they have a do-not-resuscitate (DNR) order on file. From the Medscape story (subscription required):

“Patients have an absolute right to refuse to consent to any procedure,” responded the primary care physician. The physician added, “If you think that they were not of sound mind when they signed their advance directive, you can litigate it. Good luck. Otherwise, you are making the argument that anyone who is refusing services is mentally unstable and should not be allowed such a decision. Courts have ruled this wrong, and patients are militant about preserving this right. Get in their way, and you will become a target.”

A psychiatrist agreed and added, “You may say that a person who cut his wrists in a bout of depression is ‘not competent’ by logical necessity, so his wishes to die are not to be honored; but the whole point of a DNR is that the person is competent when the DNR is signed, so his wishes can be honored later when he is not competent.”

Wait a minute! A DNR says do not give cardio/pulmonary resuscitation. It doesn’t require that nothing be done medically. For example, in a Wooltorton-type case, a DNR should not preclude stomach pumping.

Even if the care required is CPR, I think this ER doc had the right idea:

“DNR applies to natural death. If he’d been shot in a gang drive-by, you’d resuscitate. A self-inflicted gun-shot wound is no different.”

Exactly.

Unlike other physicians, ER doctors’ sole role is to save lives and stabilize patients for release or transfer to another ward. It would be dangerous to make ER docs take their eyes off that ball to search for what a patient might want before engaging the situation medically.  (Indeed, that’s why hospice tells families not to call an ambulance when their loved one starts actively dying.) 

Nor should ER docs be expected to “complete” failed suicides by letting their patient die. If the law is ambiguous on that point, change the law. 

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