Skip to main content

Research Repository

Advanced Search

Advance decisions to refuse treatment and suicidal behaviour in emergency care: 'It's very much a step into the unknown'

Quinlivan, Leah; Nowland, Rebecca; Steeg, Sarah; Cooper, Jayne; Meehan, Declan; Godfrey, Joseph; Robertson, Duncan; Longson, Damien; Potokar, John; Davies, Rosie; Allen, Neil; Huxtable, Richard; Mackway-Jones, Kevin; Hawton, Keith; Gunnell, David; Kapur, Nav

Authors

Leah Quinlivan

Rebecca Nowland

Sarah Steeg

Jayne Cooper

Declan Meehan

Joseph Godfrey

Duncan Robertson

Damien Longson

John Potokar

Rosie Davies Rosemary3.Davies@uwe.ac.uk
Research Fellow in Patient and Public Invol

Neil Allen

Richard Huxtable

Kevin Mackway-Jones

Keith Hawton

David Gunnell

Nav Kapur



Abstract

© 2019 The Royal College of Psychiatrists. Background Complex challenges may arise when patients present to emergency services with an advance decision to refuse life-saving treatment following suicidal behaviour.Aims To investigate the use of advance decisions to refuse treatment in the context of suicidal behaviour from the perspective of clinicians and people with lived experience of self-harm and/or psychiatric services.Method Forty-one participants aged 18 or over from hospital services (emergency departments, liaison psychiatry and ambulance services) and groups of individuals with experience of psychiatric services and/or self-harm were recruited to six focus groups in a multisite study in England. Data were collected in 2016 using a structured topic guide and included a fictional vignette. They were analysed using thematic framework analysis.Results Advance decisions to refuse treatment for suicidal behaviour were contentious across groups. Three main themes emerged from the data: (a) they may enhance patient autonomy and aid clarity in acute emergencies, but also create legal and ethical uncertainty over treatment following self-harm; (b) they are anxiety provoking for clinicians; and (c) in practice, there are challenges in validation (for example, validating the patient's mental capacity at the time of writing), time constraints and significant legal/ethical complexities.Conclusions The potential for patients to refuse life-saving treatment following suicidal behaviour in a legal document was challenging and anxiety provoking for participants. Clinicians should act with caution given the potential for recovery and fluctuations in suicidal ideation. Currently, advance decisions to refuse treatment have questionable use in the context of suicidal behaviour given the challenges in validation. Discussion and further patient research are needed in this area.Declaration of interest D.G., K.H. and N.K. are members of the Department of Health's (England) National Suicide Prevention Advisory Group. N.K. chaired the National Institute for Health and Care Excellence (NICE) guideline development group for the longer-Term management of self-harm and the NICE Topic Expert Group (which developed the quality standards for self-harm services). He is currently chair of the updated NICE guideline for Depression. K.H. and D.G. are NIHR Senior Investigators. K.H. is also supported by the Oxford Health NHS Foundation Trust and N.K. by the Greater Manchester Mental Health NHS Foundation Trust.

Journal Article Type Article
Acceptance Date May 13, 2019
Online Publication Date Jun 13, 2019
Publication Date Jul 1, 2019
Deposit Date Sep 5, 2019
Publicly Available Date Sep 5, 2019
Journal BJPsych Open
Electronic ISSN 2056-4724
Publisher Cambridge University Press (CUP)
Peer Reviewed Peer Reviewed
Volume 5
Issue 4
DOI https://doi.org/10.1192/bjo.2019.42
Keywords self-harm; suicidal behaviour; emergency services; capacity; Mental Capacity Act; advance decisions; treatment refusal; qualitative research
Public URL https://uwe-repository.worktribe.com/output/2614070
Publisher URL https://www.cambridge.org/core/journals/bjpsych-open/article/advance-decisions-to-refuse-treatment-and-suicidal-behaviour-in-emergency-care-its-very-much-a-step-into-the-unknown/3365ABDAD49526E22073A5B8F801CD6F/core-reader#
Contract Date Sep 5, 2019

Files

Advance decisions to refuse treatment and suicidal behaviour in emergency care: ‘it’s very much a step into the unknown’ (302 Kb)
PDF

Licence
http://creativecommons.org/licenses/by-nc-sa/4.0/

Publisher Licence URL
http://creativecommons.org/licenses/by-nc-sa/4.0/

Copyright Statement
COPYRIGHT: © The Royal College of Psychiatrists 2019
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike licence (http://creativecommons.org/licenses/by-nc-sa/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the same Creative Commons licence is included and the original work is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use.






You might also like



Downloadable Citations