Why clinicians should provide lifesaving treatment after attempted suicide despite patient refusal

Abstract

Historically, EMTs and clinicians intervened to resuscitate patients and provide lifesaving treatment following a suicide attempt. Despite this, the literature describes a range of cases following an attempted suicide where some physicians and ethicists assert that clinicians should not resuscitate the patient or provide lifesaving interventions, and instead allow the patient to die. Building upon a recent clinical ethics consultation case, this article provides a taxonomy of cases in the literature of patients who refuse lifesaving treatment following a suicide attempt. Often, these cases occur rapidly in emergency settings, offering little time for deliberation or discussion. While adults with decision-making capacity do have a right to refuse lifesaving treatment, this right does not extend to patients whose capacity is compromised or absent. This article outlines key legal points to guide clinician actions, including considerations for capacity assessments, duties under the Emergency Medical Treatment and Labor Act, the doctrine of presumed consent, and emergency psychiatric hold laws. Integrating legal duties along with ethical principles of autonomy, nonmaleficence, and beneficence, this article provides a model recommendation to guide future cases.