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The four core principles of biomedical ethics are non-maleficence, justice, beneficence, and patient autonomy. Respect for autonomy means that doctor has to make decisions based on the patient’s moral and ethical values because the one is legally competent to make individual health choices. This principle involves a range of practices, from protecting patient information privacy to accepting do-not-resuscitate orders. However, ethical issues, especially in emergencies, are not straightforward, requiring physicians to be guided by the other three principles of medical ethics. For example, the provided scenario tells the patient’s story of being admitted to the Intensive Care Unit (ICU) after attempting suicide. The patient requires intubation because his respiration is deteriorating rapidly. However, the man’s relative brought the patient’s advance healthcare directive that states his refusal to be placed on a ventilator or any other artificial life support. This complex case requires respecting patient autonomy, but beneficence and non-maleficence should also be considered before the final decision.
The ethical issue for the psychologist who needs to consult the ICU team about the patient’s will is patient autonomy. The suicide attempt, in this case, indicates the fact that the patient was not capable of rational decisions. Therefore, the principle of beneficence dictates that he should be intubated. Still, the man’s advance directive states that he would not want to be placed on a ventilator. The meaning of his last words was ambivalent because it may either mean that the patient did not plan to be hospitalized or did not expect the overdose. Since the advance directive was written in the past year, the possible course of action for the doctors to provide oxygen and intravenous fluids, but not intubation. However, it is crucial to discuss this issue with the relative to investigate the reasons for suicide. If the patient had a terminal illness, then the terms of the advance directive should be followed. Conversely, this document cannot be accepted if the man was clinically depressed when his will was created, then this document cannot be valid.
If I were a psychologist, in this case, I would recommend disregarding the advance directive and introducing intubation to the patient. I think this document cannot be followed in this scenario because the patient tried to commit suicide, but his final words appeared to express his regret about this event. The advance directive should be considered when external factors cause health damage, but suicide cases should be carefully evaluated. In this scenario, the patient’s final words were: “This wasn’t supposed to have happened,” which may mean that he did not wish to die. Therefore, his written refusal to be on a ventilator can be disregarded. If no advance healthcare directive were provided, I would immediately suggest the ICU team intubate this man. People who attempt killing themselves cannot often make informed decisions about their health because of a potential psychiatric condition such as major depression or schizophrenia. Thus, it is critical to provide immediate help to these patients during such emergencies and offer treatment for the underlying cause later.
To sum up, this scenario involved a complex case of a patient admitted to the ICU after a suicide attempt. The team is hesitant to perform intubation due to the man’s advance directive that expresses his wish to refuse any form of artificial life support. However, the patient’s last words suggest that this document can be ignored in this particular case, and all the necessary procedures should be done to save the man’s life, placing beneficence and non-maleficence above autonomy.
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