What to do with a neglectful patient who refuses surgery

On p 809 Inwald describes an elderly man with schizophrenia living in an unkempt state, who was diagnosed as having a rectal prolapse but refused surgery. While discussions were continuing between the general practice, social services, surgeons, and psychiatrists about what to do the man died of a haemorrhage from his prolapse. Commenting on what might have been done J and S Hippisley-Cox argue that the issue of competence is key: if competent, the man's refusal must be respected. They suggest that the courts could have been asked to rule on competency. Hill-Smith, however, admires the care this patient received and the thought those involved gave to it. The fact that the man's decision was respected, he says, was itself a success.


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Relevant Article

Ethical dilemma: Competency, consent, and the duty of care • Best of motives, worst of consequences • Let the courts decide • The only failure was the outcome
A C Inwald, Julia Hippisley-Cox, Stephen Hippisley-Cox, and Ian Hill-Smith
BMJ 1998 317: 809. [Extract] [Full Text] [PDF]

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