Do-Not-Resuscitate Orders in Suicide Attempts
Do-Not-Resuscitate Orders in Suicide Attempts
Nursing 410
Introduction
The National Institute of Mental Health (NIMH) has published a fact sheet of statistics on suicide in the United States. In 2007, it is reported that suicide was the tenth leading cause of death. Furthermore, for every suicide committed, eleven were attempted. A total of 34,598 deaths occurred from suicide with an overall rate of 11.3 suicide deaths per 100,000 people. (NIMH, 2010). Risk factors were also noted on this report and listed “depression and other mental disorders, or a substance abuse disorder (often in combination with other mental disorders). More than ninety percent of people who die by suicide have these risk factors (NIMH, 2010).”
Since the mid-1970’s, mentally competent individuals have had the option to forego life saving or life sustaining treatment through the implementation of Do-Not-Resuscitate (DNR) orders (Cook, Pan, Silverman, & Soltys, 2010). Medical codes of ethics, public policies, and judicial decisions advanced in the 1990’s with the development and implementation of the Patient Self-Determination Act (PSDA) which facilitates a patient’s autonomy through knowledge and use of advance directives that consists of one or all of the following: living will, medical care directive, and durable power of attorney (Butts & Rich, 2008). An advance directive is an important tool in assisting the medical profession in knowing how aggressive they need to be in treating patients that are unable to make their wishes known. Many individuals with terminal illnesses have an advance directive and DNR in place that was developed while the individual was considered to be mentally competent. The problem, however, comes when an individual obtains a DNR and develops an advance directive as part of their suicide plan. These individuals generally are not considered to be mentally stable. This leads to the dilemma of do we, as healthcare professionals, ignore the
Nursing 410
Introduction
The National Institute of Mental Health (NIMH) has published a fact sheet of statistics on suicide in the United States. In 2007, it is reported that suicide was the tenth leading cause of death. Furthermore, for every suicide committed, eleven were attempted. A total of 34,598 deaths occurred from suicide with an overall rate of 11.3 suicide deaths per 100,000 people. (NIMH, 2010). Risk factors were also noted on this report and listed “depression and other mental disorders, or a substance abuse disorder (often in combination with other mental disorders). More than ninety percent of people who die by suicide have these risk factors (NIMH, 2010).”
Since the mid-1970’s, mentally competent individuals have had the option to forego life saving or life sustaining treatment through the implementation of Do-Not-Resuscitate (DNR) orders (Cook, Pan, Silverman, & Soltys, 2010). Medical codes of ethics, public policies, and judicial decisions advanced in the 1990’s with the development and implementation of the Patient Self-Determination Act (PSDA) which facilitates a patient’s autonomy through knowledge and use of advance directives that consists of one or all of the following: living will, medical care directive, and durable power of attorney (Butts & Rich, 2008). An advance directive is an important tool in assisting the medical profession in knowing how aggressive they need to be in treating patients that are unable to make their wishes known. Many individuals with terminal illnesses have an advance directive and DNR in place that was developed while the individual was considered to be mentally competent. The problem, however, comes when an individual obtains a DNR and develops an advance directive as part of their suicide plan. These individuals generally are not considered to be mentally stable. This leads to the dilemma of do we, as healthcare professionals, ignore the
References: American Nurses Association (2010). Nursing Scope and Standards of Practice. (2nd ed.) Silver Spring, MD: Author. Butts, J. B. & Rich, K. L. (2008). Nursing Ethics Across the Curriculum and Into Practice. (2nd ed.) Sudbury Ma: Jones and Barlett Publishers, LLC. Cook, R., Pan, P., Silverman, R., Soltys, S.M., (2010). Do-not-resuscitate orders in suicidal patients: clinical, ethical, and legal dilemmas. Psychosomatics, 51(4), 277-282. Retrieved from www.ncbi.nlm.nih.gov/pubmed/20587754. Geppert, C.M.A., (2011). Saving life or respecting autonomy: The ethical dilemma of DNR orders in patients who attempt suicide. The Internet Journal of Law, Healthcare and Ethics, 7(1). Retrieved from http://www.ispub.com:80/journal/the-internet-journal-of-law-healthcare-and-ethics/volume-7-number-1/saving-life-or-respecting-autonomy-the-ethical-dilemma-of-dnr-orders-in-patients-who-attempt-suicide.html. Patel, A.Y., (2012). Suicide by Do-Not-Resuscitate Order. American Journal of Hospice and Palliative Medicine, 00(0), 1-3. Doi: 10.1177/1049909112438461. U.S. Department of Health and Human Services, National Institute of Health, National Institute of Mental Health. (2010). Suicide in the U.S.: Statistics and prevention. (NIH Publication No. 06-4594). Retrieved from http://www.nimh.nih.gov/health/publications/suicide.