Should a DNR Be Honored for Patient with Suicidal Thoughts?

Case Narrative

Amy is a 52-year-old with a medical history of heart failure, hypertension, diabetes, chronic kidney disease, depression, and anxiety. She voluntarily goes to the emergency department because she is experiencing suicidal thoughts and is seeking treatment for symptoms of depression. She has not attempted suicide. Her electronic medical record shows that she has a Do Not  Resuscitate (DNR) order, which she made about a year earlier. When asked about it in the ER, Amy affirms that if her heart stops, she does not want to be resuscitated. The attending physician believes she does not have the capacity to make this decision because of her suicidal thoughts. Clinical ethicists are consulted to help resolve this issue.

Ethical Analysis and Process

The attending physician asked us, the ethicists, how to determine if Amy has decision-making capacity. We explained that a psychiatric disorder such as depression, which Amy sought treatment for,  might alter a patient’s decision-making capacity, but that that’s not always the case. Having a psychiatric disorder alone does not preclude decision-making capacity. Amy’s