Refusal of life-sustaining treatment after a suicide attempt in an older adult: Medico-legal and ethical reflections from Greece

Suicide attempts by older adults can present complex clinical, ethical and legal challenges. While less common than in younger people, they have a higher 'success' rate. When older patients who have attempted suicide subsequently refuse life-sustaining treatment, clinicians must use their medical judgment, have regard for any psychiatric assessment, patient autonomy and local legal frameworks. We report the case of a 93-year-old man admitted to the University Hospital of Heraklion, Greece, who deliberately overdosed on insulin, which resulted in hypoglycaemia and acute-on-chronic kidney injury. Following stabilisation, the patient - whose spouse had recently died and who lived alone - refused haemodialysis. He had full decision-making capacity confirmed by psychiatric evaluation. Conservative management was pursued in collaboration with nephrology, psychiatry and palliative care teams. The patient's renal function gradually improved and he was discharged following recovery. This case underscores the need for a multidisciplinary approach which integrates acute medical care, geriatric assessment and ethical reflection. Respecting the patient's informed refusal of dialysis was consistent with the principles of patient autonomy, beneficence and non-maleficence, and was legally supported under Greek law, which permits passive but not active euthanasia. It illustrates that patient-centred, conservative management can align ethical integrity with clinical prudence, even after a suicide attempt. The case highlights the ethical and legal justification for honouring informed treatment refusal in competent older adults and emphasises the importance of individualised, compassionate care that respects dignity and autonomy at the end of life.