What ethical principle guides a provider's recommendation to admit a patient with severe depression and multiple suicide attempts to a hospital for their safety?

Beneficence Guides Hospital Admission for Suicidal Adolescent

The provider's recommendation to admit this young girl to the hospital is primarily guided by the ethical principle of beneficence—the duty to act in the patient's best interest and promote her wellbeing by placing her in a safe, protected environment where she can receive comprehensive psychiatric evaluation and treatment. 1, 2

Understanding the Ethical Framework

The decision to hospitalize involves multiple ethical principles working together, but beneficence takes precedence in this acute safety situation:

Primary Principle: Beneficence

• Beneficence requires physicians to act in the patient's best interest and promote their wellbeing, which in this case means preventing further suicide attempts through hospitalization. 3, 4
• The American Academy of Pediatrics explicitly states that for adolescents at moderate or high risk of suicide who have made attempts, the safest course of action is psychiatric hospitalization, placing them in a safe and protected environment. 1
• This protective action fulfills the physician's duty to provide benefit by ensuring survival and creating conditions for recovery, even when the patient initially resists. 2, 5

Supporting Principle: Nonmaleficence

• Nonmaleficence (avoiding harm) also supports this decision by preventing the serious harm or death that could result from another suicide attempt. 3, 4
• The provider is acting to minimize the risk of the patient harming herself, which is a fundamental medical duty. 1, 6

Autonomy Considerations

• While respect for patient autonomy is important, in situations involving severe depression with multiple suicide attempts, the principles of beneficence and nonmaleficence appropriately override the patient's immediate wishes when she lacks capacity to make safe decisions about her care. 1, 3
• The patient's anger and upset feelings do not negate the medical necessity of protective intervention when life is at risk. 1

Clinical Context Supporting Beneficence

High-risk indicators present in this case that justify beneficence-driven hospitalization include:

• Multiple previous suicide attempts (indicating persistent risk and low impulse control). 1, 2
• Severe depression (a major psychiatric illness requiring intensive treatment). 1, 5
• The patient's resistance to help (inability to engage in safety planning). 5

Hospitalization provides specific benefits that fulfill the principle of beneficence:

• Time for complete medical and psychiatric evaluation in a controlled setting. 1, 2
• Initiation of therapy while ensuring physical safety. 1, 5
• Arrangement of appropriate mental health follow-up care. 1, 2
• Protection during the highest-risk period immediately following a suicide attempt. 2, 5

Why This Is Not Primarily Justice

Justice relates to fair distribution of healthcare resources and treating all people equally and equitably. 3, 6 While the patient deserves equal access to psychiatric care, the immediate decision to hospitalize is driven by her individual medical need for safety and treatment (beneficence), not by concerns about equitable resource allocation. 1

Answer to the Question

The correct answer is B - Beneficence. The provider is fulfilling the ethical duty to act in the patient's best interest by recommending hospitalization to protect her life and provide necessary psychiatric treatment, even though she is upset about this decision. 1, 2, 3