Case No. 6: A woman with terminal cancer tries to commit suicide but fails.
A 58-year-old woman with terminal cancer had already made one suicide attempt. When friends didn’t hear from her for a few days, they called her building’s superintendent, who found her alive but barely breathing. She was taken to the hospital, where she was put on a ventilator and slipped into a coma. She didn’t have a living will, but her health-care proxy asked doctors to discontinue the ventilator to “finish” the suicide. Clearly, the proxy reasoned, the patient didn’t want to live. Doctors had to consider whether by doing so they were simply withdrawing “extraordinary means” or committing an illegal act by assisting suicide.
Suicide attempts can create especially tricky ethical situations because they raise complicated questions about a patient’s intent. In a case like this, “the patient’s suicidal behavior cannot automatically be considered an expression of her true wishes, because her actions to harm herself were potentially related to her depression,” says Deborah Korzenik of Beth Israel. Assisted suicide is also illegal in New York State; doctors therefore can’t participate in “finishing” the suicide. Instead, they have to figure out what course of action the patient would have wanted. Doctors tend to balk if they feel like they’re aiding a suicide, says Nancy Dubler of Montefiore Medical Center. Their objections are heartfelt, she says, but they must put these feelings aside. “The point isn’t to assist or not assist a suicide; it’s to respect the wishes of a previously capable patient.”
When the patient arrived at the hospital, doctors were not fully aware of the extent of her cancer or the brain damage from her suicide attempt. They therefore decided to leave her on the ventilator until they could determine whether her situation was reversible and what her previously stated wishes were, if she had made any. According to the proxy, the patient had stated that life with incurable cancer wasn’t worth living. “It is therefore easy to imagine that she would find life with brain damage and cancer to be even less worth living,” says Rosamond Rhodes of Mount Sinai. Once the doctors learned the full extent of the damage—that she was experiencing organ failure and other irreversible problems—they reasoned that they were simply prolonging her inevitable death. Removing the ventilator would not be assisted suicide, but rather a fulfillment of her end-of-life wishes. The proxy was informed and assented. Before the ventilator could be removed, the patient’s heart stopped, and she was not resuscitated.