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Self-Inflicted Gunshot Wound/Self-Reported No Code Status: The Doctor’s Dilemma: Suicidal Patients 

Self-Inflicted Gunshot Wound/Self-Reported No Code Status: The Doctor’s Dilemma: Suicidal Patients
Chapter:
Self-Inflicted Gunshot Wound/Self-Reported No Code Status: The Doctor’s Dilemma: Suicidal Patients
Source:
Legal and Ethical Issues in Emergency Medicine
Author(s):

Raquel M. Schears

and Markayle R. Schears

DOI:
10.1093/med/9780190066420.003.0009

Suicidal ideation and attempted suicide are important presenting complaints in the emergency department (ED). The juxtaposition of a self-inflicted gunshot wound and self-reported no code status may serve to amplify the moral distress of attending emergency providers. Imagine caring for a terminal yet capable patient, who independently attempts suicide unsuccessfully and is brought to the ED with an advance directive (AD) requesting no treatment. The exceptional consideration in this suicidal context is whether the treatment can be effective. In a case with a very low likelihood that any intervention could produce a good outcome, clinical judgment becomes the basis for withholding or withdrawing treatment, not the AD.

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