{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T06:55:04Z","timestamp":1791442504468,"version":"4.3.3"},"reference-count":26,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Med Leg J"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>Suicide attempts by older adults can present complex clinical, ethical and legal challenges. While less common than in younger people, they have a higher \u2018success\u2019 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 \u2013 whose spouse had recently died and who lived alone \u2013 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\u2019s 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\u2019s 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.<\/jats:p>","DOI":"10.1177\/00258172261419306","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T10:09:06Z","timestamp":1773914946000},"page":"169-172","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Refusal of life-sustaining treatment after a suicide attempt in an older adult: Medico-legal and ethical reflections from Greece"],"prefix":"10.1177","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1082-5674","authenticated-orcid":false,"given":"Petros","family":"Ioannou","sequence":"first","affiliation":[{"name":"School of Medicine, University of Crete, Heraklion, Greece"},{"name":"Internal Medicine Department, University Hospital of Heraklion, Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuil","family":"Laskaridis","sequence":"additional","affiliation":[{"name":"Emmanouil Laskaridis &amp; Partners Law Office, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimia","family":"Ntotsika","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, University Hospital of Heraklion, Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Symeon","family":"Panagiotakis","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, University Hospital of Heraklion, Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diamantis","family":"Kofteridis","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Crete, Heraklion, Greece"},{"name":"Internal Medicine Department, University Hospital of Heraklion, Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2024.1395462"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2024.1449526"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/1559827614551130"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/CNQ.0000000000000410"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-014-0169-3"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/NJH.0000000000000444"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/SPC.0000000000000110"},{"key":"e_1_3_2_9_2","unstructured":"Article 128 of the Greek Civil Code."},{"key":"e_1_3_2_10_2","unstructured":"Article 1666 of the Greek Civil Code."},{"key":"e_1_3_2_11_2","unstructured":"Article 131 of the Greek Civil Code."},{"key":"e_1_3_2_12_2","unstructured":"Areopag 1733\/2024 Nomos data base."},{"key":"e_1_3_2_13_2","doi-asserted-by":"crossref","unstructured":"Land Court of Larissa 26\/1955 \u0391rchN 6 117.","DOI":"10.1049\/sqj.1955.0074"},{"key":"e_1_3_2_14_2","unstructured":"Areopag 241\/1967 NoB 1967 988."},{"key":"e_1_3_2_15_2","unstructured":"Thessaloniki Court of Appeal 631\/1970 Arm 1970 974."},{"key":"e_1_3_2_16_2","unstructured":"Land Court of Achaia 370\/2025 Nomos data base."},{"key":"e_1_3_2_17_2","unstructured":"conf. 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