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A Suicidal Patient in the Burn Unit

AC is a 27-year-old radio personality, who was admitted to the trauma unit after sustaining multiple fractures and blunt trauma to the chest, head, and abdomen in a motor vehicle accident. He had been smoking marijuana and drinking alcohol while driving when he fell asleep, running his car into an overpass. He was resuscitated at the scene and required nasotracheal intubation due to massive facial trauma. He was diagnosed with a C6 spinal fracture and was paralyzed below the waist. He attempted to wave off the surgeons in the emergency department and became combative when they attempted to treat him. He was declared incompetent and was sedated. He underwent several surgeries that night (including spinal fusion) and grudgingly consented to further treatment including skin grafts to the face in subsequent weeks. He survived treatment but became increasingly angry and despondent in the intensive care unit (ICU). He now argues that he should have been allowed to die on the night of the accident and that he attempted to refuse treatment in the emergency department. He states he does not (and would never) want to live with the degree of impairment he has sustained. To make matters worse, his vocal cords were damaged during the incident and his voice is no longer broadcast quality. AC threatens to commit suicide as soon as he is released from the hospital. The palliative medicine team is consulted.