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A Cry for Help…,[object Object],What should an MD do when a patient returns to the ER after 3 suicide attempts?,[object Object],Kayla Poret, RN, WCC,[object Object]
Here is  Maxa 55-y.o. brought into the ER after a 3rd suicide attempt using rat poison…..,[object Object],[object Object]
Alienated from his children
Chronically depressed
Has prescriptions for antidepressants, but has stopped  taking them because they caused him to feel sleep
He is incoherent and semiconcious,[object Object]
What is the dilemma?,[object Object],Should Max be held for 72 hours , in which two physicians deem him dangerous to himself or others? Should the doctor sign the involuntary commitment and initiate another round of therapy?  ,[object Object],DEFINITLEY!!! ,[object Object],Max is a danger to himself,[object Object],He is incoherent and semiconscious,[object Object],He has rat poison in his blood,[object Object],He cannot make sound judgment at this time,[object Object],He has had 3 failed suicide attempts,[object Object],Point Made…..HE IS REACHING OUT FOR HELP!,[object Object]
Attempted Suicide “AKA” Parasuicide,[object Object],parasuicide /para·sui·cide/ (-soo´ĭ-sīd) attempted suicide, emphasizing that in most such attempts death is not the desired outcome. Dorland's Medical Dictionary for Health Consumers,[object Object]
What is it to involuntarily commit someone?,[object Object],the practice of using legal means or forms as part of a mental health law to commit a person to a psychiatric hospital or ward against their will and/or over their protests.,[object Object],www.wikipedia.org,[object Object]
Ethically: What should the ER Doctor do?,[object Object],Involunarily Commit Him?,[object Object],Discharge him,[object Object],Priniple: Beneficence—To do only good for others,[object Object],Using proportionality: choosing the option that produces more good than harm ex: determining the best treatment in a given situation,[object Object],If the doctor involuntarily commits Max, then he will be doing only good for him…,[object Object],There is a very high risk that Max will try another attempt of suicide.  By discharging him, is the doctor not disobeying the ethical principle: Nonmalifience—because he will have unintentionally participated in another suicide attempt by Max should it play out.,[object Object]
“Suicide attempts that do not result in death are much more common than completed suicides. Many of these suicide attempts are carried out in a way that makes rescue possible. These attempts often represent a desperate cry for help.,[object Object],The method of suicide may be somewhat nonviolent, such as poisoning or overdose. Males, especially elderly men, are more likely to choose violent methods, such as shooting themselves. As a result, suicide attempts by males are more likely to be completed.”,[object Object],Apparently, Max was crying out for help, because he chose poisoning, which is usually “not as lethal”,[object Object],So now, it is the doctors duty to be the rescuer, not the one who slaps him on the wrist, hoping that he has learned his lesson….,[object Object],http://health.nytimes.com/health/guides/disease/suicide-and-suicidal-behavior/overview.html,[object Object]
Max is a candidate for involuntary commitment and another round of therapy ,[object Object],Medication adjustment,[object Object],Plan of Care Evaluated,[object Object],Support,[object Object],Psychoanalytic therapy,[object Object],discharge,[object Object],Another round of therapy,[object Object]
Is the threat of a lawsuit really worth someone’s life? There is hope for Max with the proper therapy.,[object Object],Cognitive Therapy Reduces Repeat Suicide Attempts by 50 Percent,[object Object],Recent suicide attempters treated with cognitive therapy were 50 percent less likely to try to kill themselves again within 18 months than those who did not receive the therapy,[object Object],-The National Institue of Health (NIH),[object Object],It is the doctor’s responsibility to commit Max for treatment,[object Object],He holds the key to potentially the last chance for intervention,[object Object]
What is Max’s current condition?,[object Object],Incoherent ,[object Object],Semiconcious,[object Object],He is not in any condition to decide what is good for him at this time…..,[object Object],So, when he does become competent, prior to 72 hours, shouldn’t he be in a safe place, where he can be protected from himself?,[object Object],He has no family support..,[object Object]
Prognosis After Suicide Attempt: Standard of Care and the Consequences of Not Meeting ItReid, William H. MD, MPH,[object Object],A significant number of people who attempt suicide and survive eventually die by their own hands, many within a year of the index attempt. A history of multiple past attempts further increases risk of eventual suicide. That most attempters do not later die by suicide is a statistical fact that should not distract psychiatrists and other mental health professionals from the substantial increase in risk associated with a suicide attempt. Short-term intensive treatment, often with psychiatric hospitalization, reduces immediate risk, but the standard of care often requires more than just a few days of generic inpatient care. Before discharging patients, the psychiatrist should be reasonably certain that the conditions associated with the attempt and initial suicide risk have improved in some significant and lasting way. Although for many patients, severe suicide risk is a relatively transient condition, patients should not be discharged just because they say they feel better or show superficial signs of lessened risk. Before sending the patient into the community, the psychiatrist should have good reason to believe that the dangerous condition(s) that precipitated the attempt and hospital admission have been ameliorated, and that the important improvements in the patient and his or her environment, on which the patient's safety relies, are both real and stable. (Journal of Psychiatric Practice 2009;15:141-144).,[object Object]
Another Ethical principle: Justice,[object Object],The MD can not justify discharging Max without proper  treatment,[object Object],The MD has all the needed proof to justify his decision to hold Max for the 72 hours that he is allowed with an involuntary commit.,[object Object],The MD owes it to Max to be his advocate and treat him equally as he would first time suicide attempted patients.,[object Object],He should not be judged by the staff of MD because of his previous attempts,[object Object]

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Suicide