Consent and Coercion

Anne is 68 and has had multiple sclerosis (MS) for more than 20 years. As a result, she is completely bed bound and requires full-time care in a nursing home. She saw her GP with a complaint of a change in bowel habits and rectal bleeding and was referred for a colonoscopy. Cancer was diagnosed and originally, she consented to have surgical removal of the tumor. Anne has been listed for surgery. Anne’s adult daughter, Wendy, was her mother’s sole care provider prior to her going into the nursing home and she visits Anne every day. Wendy has expressed to the consultant her concern that the operation is not in her mother’s best interests. She says that her mother lives a miserable life, in the past she expressed a wish to die and, as the cancer presents an opportunity for her mother to die naturally, intervention would be inappropriate. After Wendy’s visit the doctor speaks to Anne, who tells him that she has changed her mind and she no longer wishes to have the operation.

• Should a change of mind about treatment be respected?
• In what circumstances can discussion with family amount to coercion such that the patient’s decision is no longer valid?

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