Suicide Attempts and Treatment Refusals

It is now well established that competent patients have a legal right to refuse life-sustaining treatment. When patients are unable to make contemporaneous medical choices, the law supports honoring treatment refusals expressed in advance directives. In contrast, just three states permit physician-assisted suicide, and their laws cover only patients with terminal illness. Moreover, in cases involving ordinary suicide, the law allows clinicians to intervene to prevent death. What should happen when a patient refuses treatment after a suicide attempt, either directly or through an advance directive? Should legal officials consider the treatment refusal part of the suicide attempt and authorize clinicians to intervene, or should they classify the refusal as an independent choice that clinicians must respect? Applying the standard U.S. approach, a court could classify a patient’s refusal as part of their suicide attempt and permit lifesaving treatment against their wishes. It is not so easy, however, to classify cases in which persons in poor physical health engage in suicidal behavior and then refuse treatment to counter the lethal effects of that behavior. This article argues it will take more than the standard causation and intent analysis to resolve these questions.