Social Question

augustlan's avatar

How do you feel about a living will being used to refuse treatment in a suicide?

Asked by augustlan (46572 points ) October 2nd, 2009

A living will has been successfully used in the UK to refuse treatment after a suicide attempt.

A) What do you think about this? Were the doctors right or wrong?
B) Do you think this will change the nature of living wills?
C) Will this have an impact on the health care reform fight in America?

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55 Answers

shilolo's avatar

She was depressed. Depressed people lose the capacity to make appropriate decisions. I would have consulted the hospital ethics board immediately and likely attempted to initiate treatment.

The_Compassionate_Heretic's avatar

I don’t see how that is ethical in any way for a doctor to honor this sort of request.

DarkScribe's avatar

In this case I fully agree with shilolo, I am amazed that was not what happened – an ethics hearing. Although they risk a lawsuit, the risk of a damaging outcome would not be high and they carry insurance specifically to protect themselves from lawsuits. I feel that there is more to this than is being disclosed.

Kraigmo's avatar

Sometimes suicide really is the best option. I think people like to avoid this fact because they are scared of encouraging those on the brink into committing suicide, when they could be saved or talked out from it. And yes, too many people with potentially bright futures have done themselves in, probably. But that doesn’t remove the fact there are some people, who are making a rational choice for themselves. This is horrible and scary, but I can’t really deny it. Even if they are mentally ill, this makes the whole ethics here questionable… but it’s not an absolute thing. Even mentally ill people can make an intelligent choice to leave this plane of existence. It’s their right as living souls who are suffering and just wants to move on. That doesn’t mean we should easily let it happen of course. We should probably always try to prevent it Maybe even in cases of living will. But its not a clear cut thing, and we shouldn’t automatically assume she should be saved from her choice.

DarkScribe's avatar

@Kraigmo _Sometimes suicide really is the best option. _

I doubt that would be the case when it is depression over difficulty conceiving.

shilolo's avatar

@Kraigmo The problem is that suicidal ideation (thoughts) is a frequent symptom of depression. Once the depression is treated, the suicidal thoughts disappear as well. Many, many people are saved from suicide (and the damage that it does to their families) by appropriate treatment for depression.

In this particular case, the treatment for antifreeze overdose is simple (fomepizole ± dialysis). It isn’t like she was suffering from a terminal illness, and then opted for this course of action in the context of a living will. In that case, I could see allowing her to die since you would be unable to correct the underlying terminal illness. Since she was otherwise healthy prior to this suicide attempt, she needed to be treated and then placed on a psychiatric hold until she was deemed safe.

augustlan's avatar

She could have been saved, and helped tremendously with therapy and medication. However, do we really want to say that depressed people are not competent to make decisions? That opens up all sorts of legal and social ramifications.

DarkScribe's avatar

@augustlan However, do we really want to say that depressed people are not competent to make decisions?

Perhaps just not irreversible life-changing (or ending) decisions.

rooeytoo's avatar

The fact that she called the ambulance makes it sound like a plea for help/attention whatever. In view of that, it seems the system as it is, let her down.

Cartman's avatar

@rooeytoo she specifically addressed her reasons for calling an ambulance in her living will.

This is a difficult question in many ways. However, assuming that she was mentally capable, then she made a conscious and competent decision to end her life. If this was a good or a bad choice is not up to others to decide. People make bad choices that end their lives all the time in: jaywalking, shooting drugs (yes it is addictive – but the first time), etc. hers was just more certain and focused. I’m not saying that one is better than the other, but as long as they are informed (no one believes shooting drugs etc. is good for you) life changing, or ending as it where, decisions should be personal.

It is a difficult and sad question but my conclusion is that people, as long as they are in control of their mental faculties, should be allowed to make their own decisions – good and bad, terminal or not. It is sad that she felt that this was her decision but who am i do judge?

My thoughts go to Kerrie and her family.

Leanne1986's avatar

I’m torn, my head says the doctors should have saved her and, as it was obvious she was very seriously depressed, she should have been given the appropriate treatment for that but my heart says if she was that desperate to end her life she would have done it regardless. You can’t help someone who doesn’t want to be helped.

noodle_poodle's avatar

Hmm its a tough one…but ultimately I would say that they made the right call…If there is one thing i believe in is that your life belongs to you alone..that’s what it is to be human and not in slavery.The decision of whether to live it or not (or as some people might perceive it, to make a bad choice) is also your own that is the double edged sword that is freedom. Deliberately disregarding someone’s wish to die is still taking a choice away from them however much it may offend some peoples perception of reality that they have this desire at all. Not everything can fixed and that is a sad fact of life

rooeytoo's avatar

@Cartman – I read the article and I think if you are serious about wanting to die, you find a faster and less reversible method than drinking antifreeze. And you don’t call the ambulance to come get you. To me it sounds like a plea for help regardless of what the note said.

But as @noodle_poodle says, I do believe it is a person’s own choice.

DarkScribe's avatar

@rooeytoo I read the article and I think if you are serious about wanting to die, you find a faster and less reversible method than drinking antifreeze

There are a number of things about this that simply don’t gel. Calling an ambulance seems strange – perhaps she was counting on them ignoring her “living will” and resuscitating her anyway – looking for publicity that might help in her quest to have a child.

That is the problem with suicides – without information from them you can only guess at what was going through their mind. She mentiones kidney failure as a potential side effect – she had researched the method, but didn’t choose a more certain and less risky (with an ambulance) one.

Maybe she was hoping to do what the hospital claimed to have motivated their refusal, put herself in a position to sue them. We can never know and it is very sad. She looks like such a nice person.

noodle_poodle's avatar

actually I didn’t read the article before my first post and after reading it…well I still stand by my comment but it seems that the woman in question doesn’t seem know what she was trying to achieve antifreeze seems like a poor choice to me…and calling the ambulance..in one way I can understand the not wanting to die alone and the body undiscovered, but in a another I think that it was extremely harsh and frankly stupid of her to put people (the medical) staff in the position she did

Cartman's avatar

@noodle_poodle OR she thought that medical staff at the hospital ER, being used to deal with severe conditions and dead, would be more suited to handle the situation than a relative or friend, having to force the door to her home and discover her body and THEN call the ambulance.

Her instructions seemed to be interpreted as a clear intention of will. Calling her stupid for for putting medical staff in a pickle seems uncalled for. Why not calling her considerate for trying to minimise the traumatic experience of her family and friends

Simone_De_Beauvoir's avatar

I think saying ‘oh she was depressed and clearly didn’t make the appropriate decisions’ just allows us to pretend we know what ‘appropriate’ decisions are..the psych world is far from a rigorous scientific world, there are so many grey areas..I would honor the living will

shilolo's avatar

@Simone_De_Beauvoir There are way too many people who either a) make a suicide attempt as a “cry for help” or b) are ultimately relieved to have been resuscitated from their drug overdose/antifreeze/half-hearted wrist slashing/etc. to believe that this is a “normal” and “appropriate” decision.

casheroo's avatar

Maybe it’s different there, but I thought a real living will has to be a legal document..not just something scribbled down.

I think that they should have saved her. In the US, I think it’d be illegal NOT to save her.

Simone_De_Beauvoir's avatar

@shilolo but who gets to decide? I know what you’re saying and of course there are people like that but there are also people who could really have that as their wish…and who gave her that diagnosis? were they a good physician? my life and mental health were ruined for a long time because some crock and shit doctor decided I was ‘depressed’ (it was right after my brother died so obviously I was upset) and put me on 10mg of Paxil to which my body reacted most unfavorably…anyway, it doesn’t matter what happened to me, the point is ..isn’t it possible that this was the wish of the patient?

casheroo's avatar

@Simone_De_Beauvoir It doesn’t matter if it’s their wish. I’m unsure if it’s illegal to commit suicide, considering a different thread we had on Fluther, but ethically, a doctor should do all he can when a patient comes in regardless of how the trauma occurred.

Simone_De_Beauvoir's avatar

@casheroo oh it is illegal to commit suicide here (which I disagree with as well) but living wills exist for a reason and the wishes of people should be respected – doctors too often do what they think ‘is best’ when it isn’t…just my opinion

Cartman's avatar

@shilolo “Normal” dosen’t make it right in the same way “abnormal” makes it wrong.

It is tricky I’ll admit but in the end this is about who should have to power do decide whether you live or die – you or someone else.

If it has been established that the person is mentally competent and fully in control, hindering someone from ending their life is, de facto, deciding if that person should live or not. Deciding that someone should live, against their wished, might seem ok but I’m decidedly uncomfortable with the reverse scenario – deciding that someone should die against their wishes (don’t bring up the death penalty here, that is a whole different discussion). The decisions in the two scenaria are of the same magnitude and If one is ok then the other is as well and vice versa.

casheroo's avatar

@Simone_De_Beauvoir Someone showed this to me http://en.wikipedia.org/wiki/Legal_views_of_suicide#United_States I don’t think it’s illegal as in a law, but it’s a common law and they commit you temporarily for it…but nothing more. And it depends on your state. I can’t find anything on NY and suicide other than assisted suicide.

Blondesjon's avatar

Why is it necessary that MY decisions about MY life and MY body not be MY own?

How many of you have your lives in such great order that you even have the time or wherewithal to try and regulate another’s?

scamp's avatar

I have a hard time believing that signing a living will before attempting suicide is simply a “cry for help.” Why take steps to make sure the effort is completed if it is only acting out?

And why would it be ok if the person had a medical illness as opposed to a mental one? I can’t understand the reasoning behind this. I agree with what @Blondesjon said above.

casheroo's avatar

@Blondesjon I don’t feel like I’m trying to regulate anyones life. I just feel when you have a mental illness, you are NOT in the right state of mind to make such a decision. And based on your views, I shouldn’t even be here..they should have let me die when I attempted at 14. People need to be helped that are suffering mentally.It’s hard for me to say this, because it was so painful when I was going through it, but a mentally ill person cannot help themselves, they need someone to step in and be the rational one…and if that’s the doctors then so be it.

tinyfaery's avatar

Ignoring someone’s specifically stated wishes based on medical, personal, legal issues is just another way doctor’s play god. Maybe she didn’t really want to die. Maybe she changed her mind at the last minute, that’s her problem; it’s the consequences of her actions. How we feel about it is irrelevant to the situation.

Blondesjon's avatar

@casheroo . . .Did you leave specific, legal instructions to be followed in the event your attempt didn’t work?

noodle_poodle's avatar

@Cartman nah I still disagree she could a gone alone and saved the professional and emotional grief from the medical staff who are over worked and under payed and simply sent a letter to coroner…its my opinion but it seems unfair to ask someone to watch you die knowing you could have saved them…if it were a crime (for instance murder) onlookers would be held accountable…I believe in personal responsibility and if someone wishes to end their life it is ultimately their choice but I see no reason to drag others into it because that is unfair and unnecessary

Cartman's avatar

@noodle_poodle If you decide to end your life, ultimately someone will be “draged into” the situation, a relative, a friend, a neighbour, etc. She can “send a letter to the coroner” but she can’t send her body!?! Maybe she just prefered it to be medical personnel, more used to handling extreme situations, over someone else. We will never know, and it doesn’t change my outlook a persons right to control their own life.

wundayatta's avatar

This is bullshit! The doctors are just using the living will to cover their asses, and avoid taking responsibility for their mistake.

I assume that suicide is illegal in England, as it is here. For the doctors to “honor” the living will is to make them accessories to suicide, if not murder. I do not believe that anyone is allowed to support an illegal act without holding some responsibility for breaking the law.

Even if England has an assisted suicide law, then I believe that there are special rules required, and hurdles to be jumped through in order to be allowed assisted suicide. It seems unlikely she went through the proper steps.

Yeah, I was right. A recent article in the New York Times says:

In a statement, Mr. Starmer said that the law — under which “aiding, abetting, procuring or counseling” suicide is punishable by up to 14 years in prison — had not changed and that there were “no guarantees against prosecution.”

I don’t think a living will should be allowed to trump the laws that make suicide illegal, especially in the case of suicide. I don’t know what this woman’s diagnosis was. Clearly she was depressed, but was it part of bipolar disorder?

My experience is that when I was depressed, I needed to put every barrier I could in front of the people who cared for me, to make it as hard as possible for them to help me. My goal was to find out if they really cared for me. In my mind (although it wasn’t clear to me, then, as it is now), I felt I had to fight their efforts because they didn’t understand that I was trying to do them all a favor. If people truly loved me, they would make sure I didn’t kill myself. If they let me kill myself, then I was right. I was unlovable.

To make it a fair test, I had to put every barrier I could in the way of those who wanted to help me. Anything else would have been asking for help, which I was not worthy of.

Her line that she wanted to die in the presence of others was another misdirection. She wanted to be saved, I believe. She called the ambulance because she believed that if people truly cared about her, they would save her, and if not, then she didn’t want to live, anyway. The fact that she drank antifreeze several times does not make a difference. Her depression made her want to punish herself. Not only did she believe she should die, but she believed she should die in as painful a way as possible—and yet, at the same time, she wanted to have people around her? Why? If she was serious about dying, she would not have given anyone a chance to stop her.

The problem is that people can not imagine what it is like to be in a mental place like that. Logic is all backwards. That’s because the pain is unbearable, and it seems like it will never end. Now, it’s possible that the pain of depression might never end, but if that’s the case; if you truly believe that, then you don’t ask to die with people around you. That is just to punish those who never cared about your pain when you are alive. You want to die, and yet you also want to punish people for allowing you to feel so bad.

Suicide is a case of passive-aggression—almost all the time. It’s about anger about the pain. It’s about the anger of feeling utterly worthless, unloved, and undeserving, yet having some idea that the whole thing is unfair. Suicide, in my opinion, is a call for help.

The only exception to that is when you can be objectively certain that the pain will never end until you are dead. If there is truly no hope for an end to pain, then the depression tells the truth, and it is a gift to be allowed to die—perhaps the only gift that has meaning for that person.

This is so tricky, because it is so hard to understand that people often don’t say what they mean because they are testing others. Yes, you have a right to control your own life, but that doesn’t mean that we are interpreting their wishes correctly. In fact, if I am right, you can never believe the words of a person who wants to kill themselves.

It is a twist on the Ulyssean dilemma. You want to hear the sirens—you want to be with them. So you tell people to not to listen to your words when you ask them to let them free. In this case, your orders are in writing—“let me die.” The problem is that this is a lie. You are under the influence of a siren call when you say that. You’re not making a decision you would make if you were in your ordinary mind.

People have trouble understanding who is the real you for people who behave in two different kinds of ways. I thought I should die, but I never wanted to die. I just wanted to be shown I was wrong. I’m still that person who needed to be shown I was lovable, and who couldn’t believe it. I now have ways of coping with those thoughts. I have learned how not to give them so much credence. It’s just a part of my malfunctioning brain. It feels like me, and it is me, but it is also not me. This is an extremely difficult distinction to make—both for me and for others.

It’s also hard for me to prove that I might know more about what was in this woman’s mind that she did. I could be wrong. I only have my experience and my belief to argue for my position. Still, wouldn’t it be prudent to be cautious? If someone makes it possible to be saved, no matter what they say, shouldn’t we err on the side of caution and save them? If they truly want to die, they will make it impossible for anyone to save them.

Simone_De_Beauvoir's avatar

@casheroo you know many people would say that anyone that wants suicide isn’t in the ‘right state of mind’ – that simply isn’t true

casheroo's avatar

@daloon GA, I can completely relate. I think people who have been in those shoes actually know what it feels like.

Yetanotheruser's avatar

@Kraigmo “Sometimes suicide really is the best option.” Suicide is generally a cry for help because the person can see no other choice.

@daloon GA! Your words reinforce what I learned from my experience with suicide prevention as a crisis intervention counselor.

Simone_De_Beauvoir's avatar

@Yetanotheruser so what? so they see no other choice? is it up to you to make them see other choices?

whatthefluther's avatar

I am a pending suicide with living will in order. I have ALS which is a progressive neurodegenerative disease. Mine is familial (genetic) and as with my grandmother my progression was relatively slow (I may make 10 years from onset; my grandmother eight). I’ve slowly become near paralyzed. Unfortunately, my breathing is now markedly affected and I do not wish to live on a ventilator….that’s just not my idea of quality of life, and that would only prolong the inevitable, as the condition is terminal. Nobody better get in my way when I decide to exercise my right to die. My suicide is well planned and it will be painless for me and not terribly messy for others. Should something go wrong (nearly impossible) my living will should ensure death on my terms. I am in favor of assisted suicide for the terminally ill. See ya….Gary/wtf

casheroo's avatar

@whatthefluther I’m in favor of it for the terminally ill as well. Being mentally ill is not the same.

Simone_De_Beauvoir's avatar

@whatthefluther exactly..and you may be an example of what some doctor says is a ‘depressed person’ because first of all how can you not be depressed (clearly) given your condition and secondly obviously you just want to ‘give up’ and therefore doctors should do anything in their power to save you and keep you a vegetable…riiight…

anyway people will say that your case is different that you’re dying anyway that you seem like you’re in clear mind but someone else may not think so…

casheroo's avatar

It’s different because he is of sound mind. How can people not see that giant difference?

Simone_De_Beauvoir's avatar

@casheroo look at lot of depressed people are of sound mind – they’re just depressed…they’re feeling like they don’t want to do anything, etc. and not all of them have a deep-rooted biological chemical imbalance…when I had postpartum depression I didn’t want to get off my bed but I was completely of sound mind to take care of my infant despite the darkness within me…he overpowered me and that’s a good thing…millions of people in the US are so called diagnosed with depression…do you think they’re all not of sound mind…go to work tomorrow, I guarantee you at least 5 of you co-workers will be on anti-depressants

casheroo's avatar

@Simone_De_Beauvoir Depressed does not equal suicidal. I’m not talking about just any depressed person. And suicidal thoughts don’t really go along with the regular diagnosis of ppd, yes it’s the same as depression only after giving birth but suicide usually isn’t the worst case scenario..infanticide is.

wundayatta's avatar

I do think that being really sick is quite depressing, and normally, I think that the depression is a call for love. However, with something that is a terminal illness, it seems to me that it can be reasonable to stop the pain by death. That’s because it is objectively true that you will not ever get better.

As to whether you can say that someone who is depressed is “of sound mind” or not—that’s a really difficult thing. I think we definitely make different decisions when depressed than we do when not depressed. I think that those decisions that you make while depressed, make sense to you at the time.

My shrink always told me not to make any big decisions when I’m down. Wait a few months. Things may appear to be different.

It can be so hard to tell the difference between not getting along with your spouse because you are depressed, and not getting along with your spouse because the relationship is shit. I think that because of the difficulty in sorting out sound minds from less sound ones, we shouldn’t help anyone make really drastic decisions. If they handle it on their own, then fine. What can you do? Otherwise, I think we should encourage people to wait another few months, and see what they think then. In the meantime, hopefully the docs will be working their asses off to help the person get rid of the depression.

I don’t want to take autonomy away from anyone, and when it comes down to it, I do think people should have a right to die on their own terms. I just think that that decision should be made because you love life (and hate pain) instead of because you hate life (at the moment) and are embracing pain; or feeling both enervated and ennobled by suffering.

In the end, I just think we can’t know if someone is in their right mind or not. Since that’s the case, we shouldn’t make any permanent decisions on their behalf. Wait. Try again in a few months.

casheroo's avatar

Okay to clarify, I never said depressed people are not of sound mind. I said people with mental illness, as in only suicidal people. Suicidal people idealize suicide. A healthy person does not.

shilolo's avatar

It truly amazed me how many people are actually advocating for some sort of right to suicide, when so much literature points to it being a sign of serious mental illness (much like a cough is a sign of pneumonia). I’ve personally treated countless patients who made some sort of suicide attempt only later to be treated for their mental illness and feel 100% better. This woman probably had an undiagnosed illness, and perhaps didn’t even entertain the notion of seeking professional help beforehand. Had she been saved from the ethylene glycol overdose (which would have likely worked), she would have then been treated by the psychiatry ward, and likely helped dramatically with her disease.

That the medical community there allowed an otherwise healthy, 26 year old woman to die is unacceptable to me. Living wills are designed to help people express their wishes should something unforeseen happen (IF I get in a car accident and am in a persistent vegetative state, pull the plug; or, IF I suffer a heart attack, do not do CPR or attach me to a ventilator). In my opinion, this action on the part of the doctors was unethical and antithetical to the Hippocratic Oath.

Simone_De_Beauvoir's avatar

@casheroo but is depression not a mental illness? it is defined as that, no?
@shilolo you do what you think is right. your interpretation of the hippocratic oath is as such. that’s all. the hippocratic oath is up to interpretation as in the case of my doctors refusing to perform abortions…much good they’re doing, right.

Yetanotheruser's avatar

@whatthefluther I agree with DNR orders and living wills, especially for terminally ill patients. I think that is an area which should be separated from the general conversation about suicide, because, as in your case, the process is well thought out and not a cry for help.

@Simone_De_Beauvoir “is it up to you to make them see other choices?” If someone comes to me telling me they have no other choice, I will always show them other choices. If I come across someone in the act, I would rather err on the side of saving a life.

shilolo's avatar

@Simone_De_Beauvoir Ah, the straw man appears. Some doctors refuse to provide abortions, therefore ethics are relative? I don’t think so. Having studied medical ethics, I can tell you that, while there are no absolutes, standing idly by while an otherwise healthy person commits suicide is unethical.

DarkScribe's avatar

There are many failed suicides, failing either by inefficient technique or medical intervention, who are genuinely grateful to be a live. Few failed suicides repeat, most try once and then get over whatever caused the momentary lapse.

Simone_De_Beauvoir's avatar

@shilolo no, no straw men here – I’ve never even heard of the concept till I got to wis.dm where everyone and there mother threw that term around…ethics may not be relative to you but they’re relative to many others..and some of those others are doctors…and it was a couple of days ago that I read the above document, no doctor stood while she committed suicide did they?

casheroo's avatar

@Simone_De_Beauvoir Okay I should not have said mental illness, I should have said a suicidal mentally ill person. I know people on here have to nitpick to death, and focus on one thing, but I was referring to people who are suicidal

YARNLADY's avatar

It all comes down to choices. When a person is in a state of depression to the point they are contemplating suicide, they are not in a mental state to “choose”. They are “not in their right mind”. People do have the right to decide for themselves what they want, but when the mind is impaired, they are not deciding, they are being driven by hormones.

Kraigmo's avatar

I defer my philosophical answer to daloon’s experiential answer. I disagree with daloon’s legal philosophy (since laws should be based on right and wrong…. and right and wrong should never be based on laws… since laws fail), but i totally agree with daloon’s experience, which shows that a person, even the woman named in this article, can really be wanting help despite putting every barrier up to to prevent that help. Daloon’s experience is strong evidence that doctors should ignore Living Wills in cases of dying-by-suicide, and laws should be amended to provide good faith exceptions. I don’t want doctors going to jail for just trying to make an honest decison.

wundayatta's avatar

@Kraigmo I would like to know what you think my legal philosophy is, based on what I wrote above. I reread it, but I’m still unsure as to what you are referring to.

I agree that laws should be based on right and wrong, not the other way around. I believe that if one has a serious problem with a law, one should find ways to protest the law in a non-violent way. I think that, in this case, where suicide is illegal in most places, that there is a good pragmatic reason for that, even if I think that people should have a community-sanctioned right to kill themselves under a very restricted set of circumstances that take extra pains to be sure that this is the person who wants it, not the disease that wants it. Of course, I’m not sure if that distinction can be made in a practical way, but that’s a different issue than the theoretical issue.

And despite what I said about my experience, I would caution us all not to make policy based on one person’s experience. I would like to know a lot more about other people’s impulses towards suicide before making a policy that might be relevant to only a handful of people, or even just one person. I like to believe that I am not the only person to experience what I experienced, but I can’t have any evidence of that without further investigation.

With this case—if there are two different, competing laws that govern a situation, I guess we can’t expect doctors to be constitutional or legal experts. They do their best to make a morally or legally proper decision under very tight time constraints. However, in the end, I would like to see this situation clarified, legally speaking. I strongly do not approve of this precedent, nor do I think the doctors made the right choice, but I guess the issue of whether they broke the law or not is pretty complex.

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