Advance Decisions and Attempted Suicide

Pearl has multiple sclerosis and has struggled with her condition for 20 years. Two years ago, in her early 50s, she wrote an advance decision. In it she states that she does not want to be resuscitated or receive any invasive treatments in the event that there is a deterioration of her physical health. The advance decision was dated and signed by two of her neighbors. Pearl had many discussions with her family, her husband and three adult children about her advance decision and why she was making it, and had clearly articulated her view that she never wanted to be admitted to intensive care or to receive life-sustaining treatment. Pearl has now attempted suicide by taking an overdose of co-codamol. She was found unconscious by a carer, who called an ambulance, and she has been admitted to the High Dependency Unit. Pearl’s husband tells the treating team that his wife had really struggled with her limited physical mobility and that she had told him she had had enough of her life. He says he was not surprised by her suicide attempt and does not think it would be right to treat her and return her to a life she found intolerable. He produces Pearl’s advance decision which he says was given to the family lawyer and her general practitioner.

• Should an advance decision be respected following a suicide attempt?
• What are the Ethical Issues?
• What are the Legal Issues?
• What are the Key Points of each that should contribute to the final decision?

Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)