Managing a Suicidal or Gravely Disabled Patient on an Involuntary Psychiatric Hold and Who Has End-ofLife Orders: Key Factors to Consider in an Emergency Room Setting

Abstract

Management of patients who have end-of-life orders may be complicated by the presence of an involuntary psychiatric hold for suicidality or grave disability. Decision-making factors that have been previously described include principles of medical ethics, laws and legal precedent, and examination of the motivations for end-of-life orders. However, management remains difficult, especially in time-limited settings such as the emergency room due to the wide-ranging existence of patient factors, individual ethics, and policies at governmental and hospital levels. We examined existing literature on the topic and created a structured conceptual model of key considerations for end-of-life issues during involuntary psychiatric holds in an emergency room setting, grouped into patient, involuntary psychiatric hold, system, and provider factors. These encompass the range of factors most likely to guide decision making on individual cases that emergency clinicians will face.