After a Suicide Attempt: Balancing Autonomy, Beneficence, and Nonmaleficence

After a suicide attempt, a delicate balance of autonomy, beneficence, and nonmaleficence is needed. These findings were presented during the American Psychiatric Association annual meeting held virtually May 1 to 3, 2021.

The case of a single patient presenting at the University of Florida after a suicide attempt was evaluated in terms of the clinical decisions made.

A woman aged 68 years who had a history of major depressive disorder and hypertension presented with encephalopathy, liver failure, acute kidney injury, and respiratory failure after overdosing with a mixture of opiates, acetaminophen, aspirin, zolpidem, and duloxetine.

Although encephalopathic, the patient informed her clinicians her depression was not adequately treated.

A psychiatrist evaluated the patient and determined she did not have the capacity to make clinical decisions. Her sister was contacted as her proxy.

The patient’s proxy indicated it was her sister’s wish to have a “do not resuscitate” status and that her living will declared she wanted comfort care only.

After input from legal services, the clinical team instead pursued aggressive treatment due to the suicide attempt. After 24 hours, the patient’s condition was determined to be irreversible, the do not resuscitate status was applied, and the patient died.

This case study was based on a unique situation and may not be generalizable.

This case highlighted the difficult and timely decisions required after a failed suicide attempt. The patient’s autonomy came into question due to her encephalopathic state. The choice to pursue aggressive treatment was made under beneficence, because there was the possibility the patient could improve. After it was clear the patient could not be saved, nonmaleficence was prioritized.

Although it may be challenging, clinicians must ensure a delicate balance between these 3 conflicting principles after a suicide attempt. Because suicide rates have been increasing in recent years, these considerations have become more important.

Reference

Chen P, Hobbs J. Ethical considerations after a suicide attempt: Lessons for unsettled times. Presented at: APA annual meeting 2021 May 1-3, 2021. Abstract/Poster 4583.