Conflict in Treatment Aims

A 56-year-old university lecturer has been diagnosed with inoperable lung cancer and has been admitted to an oncology ward to receive intensive radiotherapy. He also had an episode of psychosis in his 20s which required him to be sectioned under the Mental Health Act. Fortunately, following this episode he has remained well and has had a very successful career. His main concern when learning of his cancer diagnosis was that he would not get a chance to finish the current projects he was currently involved with at the university, including setting up a bursary. Shortly after arriving on the oncology ward to commence radiotherapy, he began displaying signs of psychosis. He had flight of ideas and pressured speech and was quite agitated. Multiple investigations ruled out a physical cause for these new symptoms, and in light of his previous medical history oral antipsychotic medication was started. Over the next few days his mental state worsened. He began making abusive phone calls to his family, removing his oxygen, telling ward staff he was cured of his cancer and that he was being awarded a Nobel prize. Whilst happy to continue with his radiotherapy, this patient stopped taking the antipsychotic medication prescribed by the psychiatrist. He was aware of some of the detrimental effects of his psychosis, but denied he needed medicine to resolve it and was adamant he just needed to be left in peace so that he could focus on his university work. As an articulate, intelligent man, this patient had insight that some of his beliefs and behaviors were characteristic of psychosis and hid them from the doctors; he denied saying he was cured of cancer when confronted by the consultant looking after him. His consultant is concerned – he is reluctant to continue giving radiotherapy in light of his worsening mental health, but delaying treatment for his cancer may ultimately hasten disease progression.

• Is it more important for this patient to stay on the oncology ward and receive radiotherapy or be sectioned and treated for his psychosis?
• Who should be involved in this decision?

Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)

Clinical Ethics and Law, Second edition. Carolyn Johnston, Penelope Bradbury, Series editor: Janice Ryme