What should you do about the surgery to stop the bleeding now?

A 68-year-old man attempted suicide by driving his car into a telephone pole with the intentional purpose of ending his life. He was found severely hemorrhaging and in the emergency department he refuses to give his consent for surgery necessary to stop the bleeding. He states that he wants to die. He was recently diagnosed with cancer and refused surgery to remove it. He states that his life had been complete and now, he wishes to end it. What should you do about the surgery to stop the bleeding now?

a. Follow his stated wish and withhold surgery.
b. Perform the surgery.
c. Obtain a court order to force the surgery.
d. Ask the family members for consent.


B - Perform the surgery. This patient’s injury is, in a sense, the same as a purposeful drug overdose, jumping off a bridge, or trying to shoot himself. In this case, the car is a large gun. Although an adult patient with the capacity to understand his medical care can refuse treatment, this is not the same as allowing patients to kill themselves. People actively trying to kill themselves are, by definition, not considered competent. The right to autonomy ends just short of condoning active suicide. It is assumed, in this case, that the suicide attempt was performed while under the intolerable emotional burden of recently having found he had cancer. An assumption is made that when acute life stressors lead a patient to attempt suicide that they are temporarily incompetent and psychotherapy or psychopharmacology may help him. if you review the question you will see that the case never stated that the cancer was incurable, progressive, or even fatal. You cannot let a patient kill himself while under acute psychological distress such as depression. You cannot wait for a court order for emergency surgery in a hemorrhaging patient. The family’s consent is not necessary. It is nice to have, but does not alter the reasoning stated above. If I was trying to commit suicide, it would not matter if my family comes by and says, “It’s okay, let him die.” You still have to intervene to prevent the active suicide.