Patient with schizophrenia who denies she has cancer forced to have surgery
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Patient with schizophrenia who denies she has cancer forced to have surgery
Talk about psychiatry with the community
I read this story today about a patient who has schizophrenia and denies she has cancer of the uterus. However, a judge at the Court of Protection has now ruled that she can be forced to have life-sa
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Forums » Open clinical » Psychiatry » Patient with schizophrenia who denies she has cancer forced to have surgery
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Patient with schizophrenia who denies she has cancer forced to have surgery
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Patient with schizophrenia who denies she has cancer forced to have surgery
posted at 16/10/2012 10:14 AM BST
on bmj.com
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Posts: 1447
First: 7/4/2011 Last: 22/5/2013 |
I read this story today about a patient who has schizophrenia and denies she has cancer of the uterus. However, a judge at the Court of Protection has now ruled that she can be forced to have life-saving surgery, saying "She herself lacks the capacity to make an informed decision. She denies that she has cancer at all and opposes, and is resistant to, the operation." Quote from the news piece: The judge granted declarations to the trust, which also cannot be named, that the proposed surgery under general anaesthetic would be lawful "notwithstanding K's refusal to consent to such treatment". It would also be lawful for sedation to be "administered by, and thereafter continuously monitored by, a qualified anaesthetist" before K is informed that it was proposed to carry out the surgery. http://www.huffingtonpost.co.uk/2012/10/15/nhs-cancer-woman-deluded-surgery-court_n_1967087.html ---- Has anyone come across this type of case before where the patient denies they need treatment? Would you feel comfortable being part of the team treating her? |
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Re: Patient with schizophrenia who denies she has cancer forced to have surgery
posted at 16/10/2012 12:49 PM BST
on bmj.com
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Posts: 2049
First: 12/3/2010 Last: 22/5/2013 |
Yes. I was involved with a very similar case earlier this year. Being very careful with what I say, to preserve confidentiality and to avoid contempt of court: The argument was that to accede to the patient's denial would bring on a confident prognosis of extremely unpleasant symptoms that would be difficult to nurse or deal with medically. This being so, I had no hesitation, once the Court of Protection had given consent, to prepare to bring the patient into hospital under sedation, by forcible IM ketamine injection if required, and to manage their admissions, anaesthesia and discharge in as kind and undamaging to them a way as possible, that impinged on other patients as little as possible. This required the cooperation of the Ambulance service, the Police, my theatre and nursing colleagues, and of course my surgeons. It was a LOT of work! In the event, the patient allowed themselves to be admitted, anaesthetised and operated on without demur. The outcome has so far been good, and the patient even complimented us on our treatment! John |
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Re: Patient with schizophrenia who denies she has cancer forced to have surgery
posted at 18/10/2012 1:42 PM BST
on bmj.com
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Posts: 4
First: 29/2/2012 Last: 18/10/2012 |
Hi. We had some cases refrred to the Council of Forensic Medicine and because people who have mental illness don't have capacity to act, they can't decide about their health issues. So the person who has been appointed as the conservator by the judge can decide for her. cancer is a life threatening situation therefore the physicians should treat her. does she have a conservator? In Response to Patient with schizophrenia who denies she has cancer forced to have surgery: I read this story today about a patient who has schizophrenia and denies she has cancer of the uterus. However, a judge at the Court of Protection has now ruled that she can be forced to have life-saving surgery, saying "She herself lacks the capacity to make an informed decision. She denies that she has cancer at all and opposes, and is resistant to, the operation." Quote from the news piece: The judge granted declarations to the trust, which also cannot be named, that the proposed surgery under general anaesthetic would be lawful "notwithstanding K's refusal to consent to such treatment". It would also be lawful for sedation to be "administered by, and thereafter continuously monitored by, a qualified anaesthetist" before K is informed that it was proposed to carry out the surgery. http://www.huffingtonpost.co.uk/2012/10/15/nhs-cancer-woman-deluded-surgery-court_n_1967087.html ---- Has anyone come across this type of case before where the patient denies they need treatment? Would you feel comfortable being part of the team treating her? Posted by mbillingsley |
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Re: Patient with schizophrenia who denies she has cancer forced to have surgery
posted at 18/10/2012 2:08 PM BST
on bmj.com
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Posts: 10
First: 10/8/2012 Last: 22/1/2013 |
One word 'Disgusting'.. This is beyond human rights and beyond a patients best interest. If the woman does not want surgery, (whether she has cancer or not) she absolutely should NOT be forced to have it... However, if she does because she is 'forced' and dies under anaesthetic or indeed due to complications surrounding the procedure then I hope that her family take the NHS, government etc to the cleaners.... again... Disgusting |
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Re: Patient with schizophrenia who denies she has cancer forced to have surgery
posted at 18/10/2012 2:15 PM BST
on bmj.com
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Posts: 10
First: 10/8/2012 Last: 22/1/2013 |
In Response to Re: Patient with schizophrenia who denies she has cancer forced to have surgery: Yes. I was involved with a very similar case earlier this year. Being very careful with what I say, to preserve confidentiality and to avoid contempt of court: The argument was that to accede to the patient's denial would bring on a confident prognosis of extremely unpleasant symptoms that would be difficult to nurse or deal with medically. This being so, I had no hesitation, once the Court of Protection had given consent, to prepare to bring the patient into hospital under sedation, by forcible IM ketamine injection if required, and to manage their admissions, anaesthesia and discharge in as kind and undamaging to them a way as possible, that impinged on other patients as little as possible. This required the cooperation of the Ambulance service, the Police, my theatre and nursing colleagues, and of course my surgeons. It was a LOT of work! In the event, the patient allowed themselves to be admitted, anaesthetised and operated on without demur. The outcome has so far been good, and the patient even complimented us on our treatment! John Posted by John D The fact that as a doctor you would go with this if told to is disgusting. I appreciate doctors save lives, but whether capable of making a informed decision or not, does not give any doctor the right to 'perform' surgery, especially as complications can arise from having such surgery. If a patient does not want it, whether capable or not they should have their 'little' voice heard and accepted in surgery cases and this includes electric shock treatment... !! |
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Re: Patient with schizophrenia who denies she has cancer forced to have surgery
posted at 19/10/2012 10:24 AM BST
on bmj.com
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Posts: 1
First: 19/10/2012 Last: 19/10/2012 |
Forensic: it is not at all true that "people who have mental illness don't have capacity to act" or that "they can't decide about their health issues". Please refer to the Mental Capacity Act for more information on this. |
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Re: Patient with schizophrenia who denies she has cancer forced to have surgery
posted at 19/10/2012 2:35 PM BST
on bmj.com
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Posts: 176
First: 13/10/2009 Last: 22/5/2013 |
John D did well in what must have been a pretty taxing time. The crucial point here is that the mental illness impairs the capacity to make this particular decision. ( I seem to remember the schizophrenic patient with a potentially life-threatening diseased leg a few years back did not deny his leg disease but that he wanted to keep his leg and take his chances). The present patient is not consciously "choosing" to die miserablly in the foreseeable future as an alternative to surgery. I just wondered if she is on optimal treatment for her schizophrenia . Remember the scizophrenic on death row in the USA - could not be executed until the schizophrenia treated - often wondered how the doctors felt : if you provide optimal treatment , we will kill your patient ? Now that really was a moral dilemma for those of us not attuned to USA thought. processes. |
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Re: Patient with schizophrenia who denies she has cancer forced to have surgery
posted at 19/10/2012 4:25 PM BST
on bmj.com
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Posts: 2049
First: 12/3/2010 Last: 22/5/2013 |
sken, Thank you for your compliment. I'm not competent to give an opinion on psychiatric treatment. I was satisfied by my mental health colleagues that she was on optimum treatment, and by my surgical colleagues on the prognosis without their treatment. Ours was nothing compared to the American dilemma. Forensic, I presume that the "Council of Forensic Medicine" is the Turkish body, and that it has a similar role to the Court of Protection in the UK? That was set up under the UK legislation referred to by cm^4. http://www.justice.gov.uk/courts/rcj-rolls-building/court-of-protection Specificly, "to make decisions in the best interests of those who lack capacity to do so." gina, I'm sorry you are upset by this case. Please consider the alternatives for this patient, who could not understand them - severe bleeding and pain, from the bleeding and from tumour spread, either of which would have killed her, but not quickly. Surgery offered her as normal a life as she already lived, and the possibility of cure, but her mental illness prevented her considering that. John |
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Re: Patient with schizophrenia who denies she has cancer forced to have surgery
posted at 10/12/2012 11:34 PM GMT
on bmj.com
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Posts: 154
First: 19/1/2012 Last: 18/5/2013 |
Yes, although I can't share any specific cases, all the time - assessments of mental capacity are a major part of what I do for a job. I have had the pleasure of being taught by Professor Nigel Eastman, a forensic psychiatrist who (so legend has it locally...) alledgedly came up with the criteria for mental capacity on the back of a napkin in a Court bathroom, whilst he was waiting to give evidence!
(NB. I am not sure if the actual historical truth is as poetic as this but the criteria for judging capacity are below. Apologies that this is a bit UK-law centric.) A good reference that is very straightforward is: http://www.nhs.uk/CarersDirect/moneyandlegal/legal/Pages/MentalCapacityAct.aspx To determine incapacity you will need to consider whether the person you're looking after has:
A person is unable to make a decision if they cannot:
The UK's Mental Capacity Act came into being is 2005 and what had been practiced as 'common law' by everyone based on cases (including C [1994] 1 All ER 819 who was the man with paranoid schizophrenia and a gangrenous leg, detained at Broadmoor) became 'statute law': I think a great guide to the 5 basic principles of the MCA can be remebered on one hand: •Everyone is assumed to have capacity until proven otherwise (thumbs up!) •Point people in the right direction (with your first finger) –give them all the relevant information, options for treatment, risks & benefits •People are allowed to make unwise decisions, with capacity (this one's a bit rude, apologies - but imagine middle finger only up :) ) •A decision made under MCA for someone else must be in their best interests (ring finger - to indicate family...this one is slightly stretching my one-hand mnemonic!)  –If the person doesn’t have capacity still take their views into account –Good practice to involve family and friends (or IMCA) •Use the least restrictive option for treatment (linked little fingers) |
Forums » Open clinical » Psychiatry » Patient with schizophrenia who denies she has cancer forced to have surgery
