During my general block, I had a patient who was involved in a motor vehicle accident and sustained polytrauma including traumatic brain injury. She was now unable to walk independently – meaning she required a catheter, she had difficulty with hand movements and coordination and thus required assistance with feeding, bathing and other daily activities. She was on a trachea; this was for approximately 2 weeks. One particular time she told me that she does not want to live anymore, she is tired of not being able to do what she used to, or do things when she wants to do them. She stated that there are a lot of family issues and causing misunderstandings within the health care professionals in terms of making health-care related decisions.

This did not settle in with me and I decided to tell my clinician and nurses, they confirmed that they are also aware of this as she has said it before. She has told almost everyone who treats or takes care of her and has mentioned that if she is ever to be in the verge of death, she must be let to die. A referral had been written to a psychologist but she has not been seen yet. What was also worrying was the fact that she was in a room that is quite further from the nurses’ station.

One morning when I came back, I noticed how she looked like she is a worse condition, getting close, I could see she was in a decerebrate pattern and had an oxygen mask on. When I enquired from the nurses about this, they told me that she had taken her trachea out, and since she stays in a room that’s further this was noted later and he had to be resuscitated, therefore the present condition is due to her being hypoxic for a period of time. After a week of being in this state, she finally passed away.

Should patients who have stated that if anything is to happen bringing them to death’s door be resuscitated when that occurs, be it they orchestrated it themselves or by any other means?. “A suicidal person with a do-not-resuscitate (DNR) order presents an ethical dilemma to the emergency physician. Many believe that suicide is an irrational action, and therefore, all suicide attempts must be treated. Others believe a DNR order should be respected even in the setting of a suicide attempt” (Henmann, 2017). In this case, this patient now suffered further as her condition had worsened from what it was, now is it worth it to have her suffering more or it’s a matter of believing that she can possibly make it and regain some function? If she had wanted to die, I cannot begin to imagine the feeling she felt having declined and suffering much worse.

As a health care professional, especially in South Africa were assisted suicides are not popular/done, watching someone die is something they cannot do. Therefore, resuscitating the patient is something that is necessary to do no matter what. It may also be because it is believed that patients make irrational decisions due to their current state, so it is not that they want to die but they are frustrated of the condition they are in.

“Not all patients who attempt suicide are necessarily incapable of making a rational decision about their health care. In some cases it may be appropriate to withhold resuscitation attempts in suicidal patients who have a preexisting DNR order. Institutional policies are needed to provide guidance in this situation”. (Henmann, 2017). Maybe if this patient had a psychologist’ review to assess and determine the rationality of this situation, a better decision could be put into action. There are people who generally want to die and those who say it due to the circumstances they are in. The question/debate of assistance suicide needs to be finalized to assist in such cases where both patients and physicians are in a stand understanding of each other and better decisions to be made.

REFERENCES 

Henman, MP (2017). JMerg Med. Suicidal patients with a Do-Not-Resuscitate order. 52(1):117-120.