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.

Please address the following questions:

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

Ans 1) Yes, the principle of patient autonomy applies here as it gives the patients the right to make their own decision whether they want to get health care assistance or not. Ethically it is not right as a physician or doctor to allow the patient die when she can be saved by giving a little more complex medical care. However, she does get the right to choose if she needs medical care or not.

Ans 2) The right to refuse the treatment is based on the legal requirement and in this case she can choose not be treated but she does not have the right to refuse it. The doctor in this can treat her without consent as she is considered mentally unstable and is not in the right state of mind to be giving consent for anything.

Ans 3) The responsibility of the ER physician in this case is to explain the patient and be empathetic towards her and make her understand why the treatment is important. As a physician, it is his responsibility to give the patient the right medications and proper treatment so that the impact of the pills is eliminated. After the treatment is done, it is important that she is referred to a good psychiatrist for further treatment.

Ans 4) No, the physician cannot participate in helping her to complete the suicide attempt as it is not legal and unethical. The patient is not mentally stables and assisting some in such thing and not treating as the patient chose not be treated is wrong.