Coroner rules that treating 26 year old woman who wanted to die would have been unlawfulBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4070 (Published 05 October 2009) Cite this as: BMJ 2009;339:b4070
All rapid responses
An underlying mental disorder should carefully be considered before withholding lifesaving treatment for suicidal patients who are deemed to have capacity to refuse such treatment
The article states that the patient had a personality disorder. This
condition is commonly associated with depression(1). The patient had
accepted lifesaving interventions up to nine times in the past but refused
any on that occasion. This could have been an indication of a depressive
illness resulting in her suicidal attempt. Studying a random sample of 229
subjects who committed suicide, Itsometsa et al (2) found that 67 of them
had personality disorder. 95% of these had a depressive syndrome, a
psychoactive substance use disorder, or both. The article mentions that
the case was discussed with clinical colleagues, a second opinion from a
fellow consultant was taken and the advice of the medical director was
sought. Nevertheless, it is not clear if a psychiatric opinion was sought.
This would have been entirely appropriate in view of the patient’s well
known mental health difficulties. In my view, a psychiatric assessment
might have found an evidence of an underlying depressive disorder. This
could have warranted the use of the Mental Health Act, which does give
powers to treat patients against their will, even if they were deemed to
have capacity to refuse treatment (3).
In my opinion, physicians should have a low threshold to seek a
psychiatric opinion, when they are considering withholding lifesaving
treatment for mentally capacitated patients who have attempted suicide,
and who are refusing such treatment.
1- Silvio Bellino et al. Combined Therapy of Major Depression With
Concomitant Borderline Personality Disorder: Comparison of Interpersonal
and Cognitive Psychotherapy. Can J Psychiatry. 2007 Nov;52(11):718-25.
2- Isometsä et al. Suicide among subjects with personality disorders. Am J
Psychiatry. 1996 May;153(5):667-73.
3- Guidance for Clinicians and SOADs: the imposition of medical treatment
in the absence of consent, published by the Care Quality Commission in
Competing interests: No competing interests