title: A case from the department of neurology.
abstract: Uncompleted suicide attempts are a significant cause of morbidity, which in catastrophic cases can be both medically and ethically challenging to manage. We discuss the case of a 63-year-old man who survived a suicide attempt by venlafaxine (Effexor) overdose, causing an intracranial hemorrhage and leaving him in an apparently awake but noncommunicative state. Ethical concerns arose when considering if he should be indefinitely maintained on life support. These include the difficulties of characterizing his level of consciousness and prognosis; establishing his decisional capacity regarding end-of-life decisions in a setting of depression and suicidality; and assessing the suitability of a surrogate decision-maker. In conclusion, we discuss whether the fact that his grave neurological condition was caused by a suicide attempt was relevant to the decision to continue or withdraw life support.
authors.affiliation: Department of Neurology, Mount Sinai Medical Center, New York, NY 10029, USA. stephen.krieger@exchange.mssm.edu
authors.forename: Stephen
authors.initials: S
authors.lastname: Krieger
authors.forename: Jennifer
authors.initials: J
authors.lastname: Finkel
authors.forename: Nada
authors.initials: N
authors.lastname: Gligorov
mesh_terms: D016223:Advance Directives; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects*; D003511:Cyclohexanols / Q000009:adverse effects*; D003657:Decision Making / Q000941:ethics; D062787:Drug Overdose / Q000150:complications; D026690:Ethics, Clinical; D006801:Humans; D008020:Life Support Care / Q000941:ethics; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000139:chemically induced*; D013406:Suicide, Attempted; D000069470:Venlafaxine Hydrochloride; D028761:Withholding Treatment
chemical_list: D018687:Antidepressive Agents, Second-Generation; D003511:Cyclohexanols; D000069470:Venlafaxine Hydrochloride