Question

The case is that of a 35 year old white, single, female who was found on her bed stuporous and moaning by her father and mother with whom she lives. There was a note in the room written by her explaining that she had carefully considered her life and what was happening to her and that she wanted to die. There was evidence in the bathroom that she had most likely taken three bottles of different pills including barbiturates. The family immediately called the paramedics and the patient was taken to the nearby hospital emergency room. The physician was presented with the note and the bottles and since the patient was not fully unconscious began to insert a nasogastric tube to aspirate the contents of the stomach. As he was attempting to get the tube down, the patient became briefly more responsive and cried out that she didn't want the tube, she didn't want any treatment and that she wanted to be left alone and allowed to die. She moaned that she had left a note which said she wanted to die and she meant it. The family arrived in the next few minutes and informed the physician that she had not seemed depressed to them and she had never seen a psychiatrist but the medications were prescribed by her general physician. When told about what she had requested of the physician, the family urged that the doctor continue treatment.

What should he do next? The physician realized that if she had consumed the pills in the bottles she would most likely not survive without medical treatment and yet it seemed clear that she did not want any treatment. The issue is whether the doctor must follow the request of the patient and stop treatment and allow her to die.

1.) Does the principle of patient autonomy apply here?

2.) Can the physician perform a treatment against the consent of the patient?

3.) What is the responsibility of the ER physician in this matter?

4.) Must the physician be required to participate in completing an attempted suicide?

Answer 1

1.The patient seems to have a mental health problem for which the general physician has prescribed the medication but the family members have a minimal knowledge regarding it .The principle of autonomy lies when a decision is made ,the person should be mentally sound .A person in this state can make decision in the way that is beneficial to them and equally have taken a great responsibility by thinking in the place of close family members, friends,etc.,.Here the patient is not in sound mind so principle of autonomy cannot be applied here legally.

2.When the patient is beneficial out of a treatment and is the standard recommended treatment (if any the hospital policy or protocols hold in making decision),psychological problems,the physician can go against the consent of patient.

3.The ER physician has to initiate the treatment as per the request of the parents to save the life of their daughter on the grounds of ethical ,moral and legal aspects

4.A physician assisted suicide is ending the life of a patient with the patient's and family's full consent.During a physician assisted suicide the physician should be present to ensure the patient passes away in a peaceful manner.