Legal and ethical aspects of refusing medical treatment after a suicide attempt: the Wooltorton case in the Australian context

Abstract

When a patient presents to hospital after a suicide attempt and appears to refuse treatment, clinicians should first assess if he or she should be treated under mental health legislation, regardless of competence to refuse treatment. When it is not possible or is inappropriate to treat under mental health legislation, the person's competence to refuse treatment should be assessed. If the patient is definitely competent, his or her decision to refuse treatment should probably be honoured. If an incompetent patient carries a document refusing treatment, clinicians must determine the validity of that document as an advance care directive — including whether or not the patient was competent at the time it was written. The law around the right to refuse treatment after a suicide attempt remains unclear and, if uncertain of what to do, clinicians should provide urgently required life‐saving treatment and simultaneously seek an urgent court order to clarify how they should proceed. In all but extraordinary circumstances, a patient who refuses treatment after a suicide attempt can and should be given life‐saving treatment, under either mental health legislation or the common law concept of necessity.

The Perception of Patients' Rights among Belgian Population

“…In view of the legislation concerning patients' rights, including euthanasia and the protection of the mentally ill, it often becomes difficult to act in an appropriate way. For example, patients refusing medical treatment after a failed suicide attempt may exercise the right to refuse treatment (13).…”

Management of patients with an advance decision and suicidal behaviour: a systematic review

“…The management of an advance decision in the context of suicidal behaviour was particularly challenging because it went against healthcare professionals’ training to preserve life (ie, adherence to the advance decision could result in the death of the patient while they could recover if they received treatment for their physical condition). This presented clinicians with a dilemma between promoting patients’ autonomy by observing their wishes stated in the advance decision and by providing care that was considered in their best interests (eg, promoting life) 7 23 26 28 30…”

End of Life Choices

“…In some places, this also includes language related to a patient's rights to refuse life-sustaining treatments (Erbay et al, 2013;Ryan and Callaghan, 2010;Saks, 2010). In some places, this also includes language related to a patient's rights to refuse life-sustaining treatments (Erbay et al, 2013;Ryan and Callaghan, 2010;Saks, 2010).…”