Right to Die V. Right to Prevent Suicide

There is a difficult and cumbersome conundrum in mental health.  There are two opposing forces which are strongly supported and have many laws and policies to support them, and once in a while – they collide.

WE HAVE THE RIGHT TO DIE

We cannot be kept alive against our will.  In 1990 the supreme court ruled in Cruzan v. Director: "A competent person has a liberty interest under the Due Process Clause in refusing unwanted medical treatment.”

In other words – any “competent” person can refuse medical treatment.  If you’re dying of cancer, or kidney failure, or anything else – you can refuse medical treatment because you have a right to die.

The Supreme Court clarified further in 1997 in Washington v. Glucksberg that we have a “constitutionally protected right to refuse life-saving hydration and nutrition”

This is why Advance Directives have become so prevalent.  If we don’t want to be kept alive on a ventilator and a feeding tube – we can refuse it ahead of time.  We can specify if we ever want to be intubated, if we want CPR, etc…

WE DO NOT HAVE THE RIGHT TO KILL OURSELVES

There is another law - the one that says we don’t have the right to kill ourselves.  In most every state there is law that states that anyone who threatens or attempts to kill themselves may be held against their will.  Yes.  If a police officer, nurse, doctor, social worker, therapist, or psychologist hears you say you are suicidal or you've attempted – they can fill out a form that binds you legally.  If a psychiatrist or any other physician agrees, you can be transferred to a psychiatric facility to be assessed and treated until you are “no longer a danger to yourself .”

Call it a "381", a "5150", a "Legal 2000" or whatever you want.  Most states will commit you to a psych hospital if you try to kill yourself.  You don't have the right.

So – You can’t kill yourself – or you can’t get caught planning it or attempting it.  It is considered a public safety issue.

NOW THE CONUNDRUM

What if someone has an advance directive saying they don’t want life saving treatment?  They don’t want to be intubated, they don’t want CPR.  It's in writing.  That person is found after a suicide attempt and taken to the hospital.  Their health is deteriorating and they go into respiratory failure.  A frantic family begs the doctors to save them.   The person is dying, which they have a right to do.  It’s because of suicide – which they do not have the right to do.

What does the doctor do?  There is a legal document from the patient that says they DO NOT want to be saved.  To intubate them or do CPR could be considered battery in this case.  Doctor’s are not to mess with individual rights and liberty – you do not ignore a DNR order. 

You also don’t let people commit suicide.  You save them, you treat them.   

  

QUESTIONS:   

Can a person obtain an advance directive stating their wish NOT to be treated, then make a suicide attempt and have that order honored?

Is a suicidal person a "competent" person?  Can they make a Do-Not-Resuscitate decision?

You Don't Know Jack

This film was VERY thought provoking. My first thought was…we are doing a terrible job as health care professionals if there were 130 people who sought Dr. Kevorkian’s assistance in killing themselves. We ought to be able to help people enjoy life. We ought to do a better job alleviating pain, so people can enjoy a quality of life. I have treated many patients who have tried to kill themselves, and I will treat many more. They change. I see them get better, I see attitudes change, and I see lives improve. I know that many of Dr. Kevorkian’s patients were terminal; we don’t need to prolong life just because we can. We need to preserve QUALITY of life. We need to make what life people naturally have, better. If their life is good, and we can prolong it, we should. If their life is miserable, we should not prolong it, but make the remainder as painless and worthwhile as possible.

I have not dealt with a family member who was suffering and had to make these kinds of decisions. I don’t know what it’s like first hand, so I can’t judge those who do.

Dr. Kevorkian went to trial and prison because he wanted to. He was assisting in suicide for many years, and decided it wasn‘t enough, he wanted to make a statement. On his last patient, he picked someone that was not terminally ill, and he didn’t want to let the patient administer the lethal injection, Dr, Kevorkian wanted to do it himself. He then went on 60 Minutes, on National Television, and showed the video tape of him killing his patient. He then taunted the prosecuting attorney and dared the state to prosecute him again. Well they did, and he was convicted of second degree murder.

He made his point. Now I am stuck trying to sort it all out. Suicide is wrong, and so is suffering. I will never condone artificially ending a patient’s life. But I will work forever to help my patients get to a point where life is worth living, and they don’t desire a hastened death. When their time comes, I hope they are ready, but I hope I can make their life good enough until then, that they want to live till their natural time comes.