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Journal Article

Citation

Badger JM, Ekman Ladd R. JONAS Healthc. Law Ethics Regul. 2011; 13(3): 79-83.

Affiliation

Departments of Nursing and Psychiatry Rhode Island Hospital (Dr Badger); Visiting Scholar in Philosophy, Brown University (Dr Ekman), Providence, Rhode Island.

Copyright

(Copyright © 2011, Lippincott Williams and Wilkins)

DOI

10.1097/NHL.0b013e31822ab019

PMID

21860274

Abstract

Patients with a history of chronic self-destructive and self-injurious behavior present many difficulties to healthcare providers. These patients often have related substance abuse and personality disorders that complicate their medical care. Treatment encounters initially may be related to medical treatment of episodic substance intoxicated states with or without self-inflicted injuries. Patients later can develop comorbid medical illnesses associated with nonadherence of treatment or iatrogenic conditions, both of which result in complex end-of-life-care decisions. Institutional familiarity of repeat patients often leaves healthcare providers feeling responsible for the patient despite having little influence over the patients' ultimate behavioral outcomes. This article describes a patient with chronic alcohol abuse, treatment noncompliance, severe personality disorder, recurrent suicidal ideation, self-injurious behavior, alcoholic cirrhosis, and suicide attempt resulting in multisystem injuries leading to an ethical conflict regarding end-of-life care.


Language: en

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