SHM Converge Scientific Abstract ePoster Gallery-Ethical Dilemmas Regarding Code Status After Suicide Attempts

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The document discusses the ethical and clinical dilemmas that arise when patients with pre-existing DNR orders attempt suicide. Using two anonymized cases, it contrasts situations in which honoring a DNR may be ethically appropriate with those in which temporary suspension may better serve the patient.<br /><br />In Case 1, an 89-year-old woman with severe chronic illness, longstanding DNR status, and an intentional opioid overdose remains delirious but may recover. In Case 2, a 78-year-old man with depression and chronic disease suffers a self-inflicted gunshot wound and may have anoxic brain injury. In both cases, the team sought psychiatry and ethics input because of concern about whether honoring the DNR would amount to participating in self-harm.<br /><br />The presentation emphasizes that decisions should not rely on a blanket rule. Instead, clinicians should consider:<br />- the likelihood and burden of CPR or intubation,<br />- whether treatment would be brief and goal-directed,<br />- whether patient resistance would make care ineffective,<br />- the expected prognosis and quality of life after treatment,<br />- whether decision-making capacity is impaired but potentially restorable,<br />- and whether surrogates can clarify the patient’s values and prior reasons for choosing DNR status.<br /><br />A key distinction is made between “DNR” and “do not treat.” The authors argue that honoring a DNR can be ethically permissible in some cases, especially when the patient’s prior wishes are clear and the intervention burden is high or outcomes poor. They suggest asking: if this were not a suicide attempt, would withdrawal or limitation of treatment be reasonable?<br /><br />Overall, the authors call for individualized, interdisciplinary decision-making involving medicine, psychiatry, and ethics. They caution against automatically suspending all DNR orders after suicide attempts, and instead recommend careful attention to autonomy, beneficence, non-maleficence, capacity, and the patient’s longstanding values.

Asset Subtitle

Rimma Osipov

Meta Tag

Author List Alissa Hutto, Anissa Berger, Anna Bystricky, Paul Ossman, Rimma Osipov

Category Clinical Vignettes

Concept Do Not Resuscitate Order

Concept Decision-Making Capacity

Concept Suicide Attempt

Concept Surrogate Decision Maker

Concept Cardiopulmonary Resuscitation

Distinguished Non-Finalist

Presenter Organization University of North Carolina Chapel Hill

Presenting Author Rimma Osipov

Track Adult

Keywords

DNR orders

suicide attempt

ethics

clinical dilemma

autonomy

psychiatry consultation

capacity assessment

end-of-life care

patient values

interdisciplinary decision-making

Do Not Resuscitate Order

Decision-Making Capacity

Suicide Attempt

Surrogate Decision Maker

Cardiopulmonary Resuscitation