Suicide by do-not-resuscitate order

Historically, medicine has been warned, "first, do no harm." In contemporary practice, however, the emergency response has generally been to err on the side of action with resuscitation efforts. Typically, it is only later on when medical therapy is considered futile that treatment is withdrawn. In such circumstances, a do-not-resuscitate (DNR) order is typically enacted as a part of an advance directive. However, when such patients attempt suicide, the approach to their care becomes complicated. Is the DNR order valid in a suicidal patient? What is the role of patient autonomy? How should an ethics consultant advise? This case details the method by which such issues should be approached in the emergent care of patients who have DNR order and attempt suicide.