Suicide and the Surrogate

Abstract

In medical toxicology, intentional drug ingestions with intent to commit suicide are a regular occurrence. Often, patients who have attempted suicide refuse lifesaving intervention. In most circumstances, emergency physicians will intervene regardless of the patient's wish to die. Their argument: patients who attempt suicide do not have the capacity to refuse lifesaving care because severe depression or psychosis has clouded their judgment. In choosing this approach, physicians make two assumptions. First, the patient's attempted suicide is directly related to psychiatric illness and not the result of a planned death in the setting of a terminal illness (euthanasia or compassionate death is an entirely different situation). Second, the patient's poorly controlled psychiatric disorder is not considered a terminal illness. The purpose of this editorial was to review medical, psychiatric, and bioethical aspects surrounding the decision to withdraw care in the suicidal patient. Two cases are reviewed where withdrawal of care was considered after suicide attempt by overdose. In the poisoned patient, medical toxicologists are poised to make significant contributions to end-of-life discussions with patients, surrogates, and care providers. Thoughtful consideration of brain death criteria and whether continued care is indeed futile will improve our framework for these mortal discussions.