Palliative Care After Suicide Attempts: Now What?

Patients who present after suicide attempts (SA) may experience a wide range of clinical trajectories, from full medical recovery to irreversible neurologic injury, multiorgan failure, or death. Although suicide prevention, risk assessment, and psychiatric treatment after a SA are well represented in the literature, comparatively little guidance exists for palliative care (PC) clinicians consulted after an SA. Care after SA lies at the intersection of critical care, psychiatry, and ethics, and raises distinctive challenges in prognostication, decisional capacity, decisions about life-sustaining treatment, and support for families and clinicians. This manuscript uses the case of Mr. A, a patient with a self-inflicted gunshot wound and uncertain neurologic prognosis, to describe a PC-informed framework for PC clinicians caring for patients after SA. In collaboration with psychiatry, ethics consultants, and the primary team, PC clinicians can help integrate medical and psychiatric prognosis, avoid anchoring on the attempt as evidence of stable values, support families struggling with guilt and stigma, manage distressing symptoms, and guide ethically grounded decision-making.