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.
- 1. Appleby L. The verdict on Wooltorton — clarifying the law [letter]. RCPsych News 2010; January. http://www.rcpsych.ac.uk/members/rcpsychnews/january2010/applebyletter.aspx (accessed May 2010).
- 2. McLean SAM. Live and let die. BMJ 2009; 339: b4112.
- 3. Bashir FA, Crawford M. Autonomy or life saving treatment for the mentally vulnerable [letter]? BMJ 2009; 339: b4400.
- 4. Dyer C. Coroner rules that treating 26 year old woman who wanted to die would have been unlawful. BMJ 2009; 339: b4070.
- 5. Smith R, Laing A, Devlin K. Doctors feared saving suicidal young woman. Sydney Morning Herald 2009; 2 Oct: 6.
- 6. Hunter and New England Area Health Service v A  NSWSC 761.
- 7. Re T (Adult: Refusal of Treatment)  EWCA Civ 18.
- 8. Airedale Hospital Trustees v Bland  UKHL 5.
- 9. Re PVM  QGAAT 1.
- 10. Brightwater Care Group (Inc) v Rossiter  WASC 229.
- 11. Secretary, Department of Health and Community Services v JWB and SMB (“Marion’s Case”)  HCA 15.
- 12. Re C (Adult: Refusal of Medical Treatment)  1 All ER 819.
- 13. Re MB (Medical Treatment)  EWCA Civ 1361.
- 14. Stewart C, Biegler P. A primer on the law of competence to refuse medical treatment. Aust Law J 2004; 78: 325-342.
- 15. Leth PM, Gregersen M. Ethylene glycol poisoning. Forensic Sci Int 2005; 155: 179-184.
- 16. F v West Berkshire Health Authority  UKHL 1.
- 17. Hall RCW, Platt DE, Hall RCW. Suicide risk assessment: a review of risk factors for suicide in 100 patients who made severe suicide attempts. Psychosomatics 1999; 40: 18-27.
- 18. Barr W, Leitner M, Thomas J. Self-harm or attempted suicide? Do suicide notes help us decide the level of intent in those who survive? Accid Emerg Nurs 2007; 15: 122-127.
- 19. Richardson G. Autonomy, guardianship and mental disorder: one problem, two solutions. Mod Law Rev 2002; 65 (5): 702-723.
- 20. Stewart C. Public interests and the right to die: compelling reasons for overriding the right to self-determination. Issues Paper 14. Sydney: Australian Institute of Health, Law & Ethics, 2001.
- 21. Bingham J, Cockcroft L, Prince R. Family of ‘living-will’ girl to sue hospital. Telegraph (London) 2009; 2 Oct: 7.
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