Critical Care

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Commentary

'Round-table' ethical debate: is a suicide note an authoritative 'living will'?

Donald B Chalfin1, David Crippen2*, Cory Franklin1, David F Kelly3, Jack K Kilcullen4, Stephen Streat5, Robert D Truog6 and Leslie M Whetstine3

Author Affiliations

1 Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York, USA

2 St Francis Medical Center, Pittsburgh, Philadelphia, USA

3 Department of Medical Ethics, Duquesne University, Pittsburgh, Philadelphia, USA

4 Department of Critical Care, Montifiore Medical Center, Bronx, New York, USA

5 Department of Critical Care Medicine, Auckland Hospital, Auckland, New Zealand

6 MICU, Children's Hospital, Boston, Massachusetts, USA

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Critical Care 2001, 5:115-124 doi:10.1186/cc1010

Published: 2 May 2001

Abstract

Living wills are often considered by physicians who are faced with a dying patient. Although popular with the general public, they remain problems of authenticity and authority. It is difficult for the examining physician to know whether the patient understood the terms of the advance directive when they signed it, and whether they still consider it authoritative at the time that it is produced. Also, there is little consensus on what spectrum of instruments constitutes a binding advance directive in real life. Does a 'suicide note' constitute an authentic and authoritative 'living will'? Our panel of authorities considers this problem in a round-table discussion.

Keywords:
advance directives; autonomy; critical care; living wills; medical ethics; suicide