surprised there is no thread on this - woman to be forced to have surgery against her wishes

[wannaBe]

here

Not sure what to think about this. On the one hand shouldn't everyone have the right to choose? But on the other, if this woman does not have the capasity to understand the consequences doesn't the medical profession have a duty of care?

Mnn, tricky that one. Presumably she urgently needs the operation, but she really needs to have her phobia looked at doesn't she?

well yes. And if she has cancer isn't there a chance she could die anyway? And if she has a fear of hospitals the treatment won't end at the surgery will it? there would have to be chemo and pposs radio therapy and other interventions that involve hospitals?

So in reality we're not talking about just one surgery that she'll be forced to have - will she be forced to have the other treatments as well?

I read that story and was in two minds about it. On the one hand it is great that 'something is being done', on the other hand, I feel the same as wannaBe. This individual will need follow up treatment. Will she be sedated for that too?
Tricky.

Interesting case. Think on balance it's the right decision. Sounds like it's been carefully and compassionately considered.

I think removal of the womb and fallopian tubes can be enough without chemo sometimes? Not sure. I suppose that the moment treatment stops being her best interest it will stop.

i wonder if her family have put pressure on them to do this?

I think that it is important to have the right to make an informed decision and if it is your choice to die, then provided you are of 'sound mind', that must be (and is) respected.

However, that woman has learning difficulties so severe that it is felt that she lacks the ability to make such a decision and truly understand the consequences of her choice.

When someone cannot truly understand the consequences of their choices then to allow them to make decisions that are harmful to them is irresponsible.

My grandma had dementia. If she didn't want to eat, ever, we could have said fine, it's your choice, you know you will die don't you? And let her. Or we could have said look, she doesn't understand what will happen, we have to act. And tube fed her. Which would you have done?

My sons have autism. They want to run out into the road. I say to them no, if you do that you may get run over and killed. They still want to run into the road. Do I let them?

I think when the person, for whatever reason, cannot make a choice understanding what it is they are doing - as it is reported is the case with that woman*, then imo, there is only one option.

*If it is not the case, then I withdraw my argument as it is based on my understanding that the woman does not have capacity.

Will the operation improve her quality of life? Will it relieve pain?

It is difficult and is why the hospital went to court to sure the right decision is made.

As I understand it she is mentally incapable of understanding the consequences of refusing treatment.

If it was somebody who fully understood that refusing treatment could kill them then they would not have persued it, people do have a right to do that.

But the key issue here is that she cannot competantly make that descision for herself.

OMG, if she wants to die let her die. She is old enough to know what she is doing.

I think thats awful that they are forcing her to have the operation. Maybe there is more to it that wasnt put in the story.

The thing is that uterine cancer is very very curable with surgery - in many cases, that is all the treatment that is needed.

OTOH, dying of endometrial cancer is a very long, drawn out process that is painful and usually involves the woman bleeding a lot for a long time amongst other things.

Ethically, for someone with limited understanding, I can see that one episode of surgery with a good chance of saving their life, and so also limiting the amount of medical intervention that would be required in the future, would be considered to be much kinder to the person involved, than letting the disease progress and having to try and deal with all the symptoms as that happened.

I know that the decision wouldn't be taken lightly

Wouldn't it be terribly hard if it was your own dd or aunt or sister with learning difficulties? It must be quite hard to decide whether or not they have the capacity to know the consequences of not having treatment or not.

If the article is right, the woman has not said she wants to die: she has agreed to the operation and then changed her mind, not because she wants to die, but because she is afraid of hospitals and needles.

So how would you handle this one if it was a close relative of your own? Would you just shrug and say "of course her fear of needles must outweight the agenda of saving her life".

Not sure I would accept this even if it was a loved one without learning difficulties tbh. But with a person without learning difficulties you could apply emotional blackmail.

mama - you do know that she has ld and lacks capacity, don't you? If my grandma with dementia did that, would you say that she was old enough to decide, or would you recognise that her state of mind meant she was not capable of understanding, really understanding the choice she was making?

My Gran needed her leg amputated a few years ago. She had broken it and basically it was killing her because she developed gangreen (sp).

We had to make the decision for her leg to be amputated as she was so out of it on drugs she couldnt choose and she kept saying no.

Once she had the operation and was back to normal again she kept asking us why we had done it. She said she would rather her passed on then be operated on.

I know its different circumstances but I think you have to listen to the person no matter what their condition.

My friend's brother had autism and developed cancer in his late twenties- it was curable with chemotherapy, but he had one course and decided he didn't like it and refused to have any more. He died.

I can see both sides of the argument, but I don't believe having ld means you have zero control over what happens to your body. The same 'lacks capacity to understand' argument has been used to justify the forced sterilisation of those with lds.

It is very tricky.

This is an entirely new area for the Court of Protection. Not the sort of case that court has dealt with before. How was the woman represented? What efforts did the court make to ascertain her views? Did they appoint advocates who have the right skills and experience to communicate with someone with this woman's type of learning disability?

It sounds like an extremely frightening series of assaults on someone who is already frightened. Of course anyone would wish that she would choose to be treated. But if she does not, are they seriously proposing to trick her into hospital - a place that she's frigthened of? If the poor woman tries to escape, are they going to use restraint holds on her - a sick woman? Are they going to repeatedly use force on this poor woman for a whole series of interventions? It's horrific.

The safeguards built in are fairly robust, I think, Edam. She would have had an Independent Mental Health Advocate or a nominated family member/friend to communicate with her and ensure her views were represented to all the paid professionals involved. There is an obligation to do everything possible to resolve the matter and help the person reach a decision before taking a decision like this on someone's behalf. And the key is whether someone has the capacity to make that particular decision, not what they decide. If they have capacity they must be allowed to make even a seemingly perverse decision.

It does seem to be a matter of life or death for someone who does not have the capacity to take a decision for herself. Though she will clearly feel very distressed at the operation and the necessity of being in hospital, it is probably a lesser evil than a preventable painful death from cancer (that might well entail hospital admission anyway...).

As I read it, the cancer is currently contained and can be removed with radical hysterectomy. If it is not removed, it may spread and will likely kill her.

Therefore - if they can remove the cancer completely, they are significantly improving her chances of survival.

As I read it, there is no suggestion of follow up treatment other than post-operative care - and I believe that this should not be covered by the court ruling.

I am also in two minds - but given that my first and second points are correct, then I think that the court was right to give the go-ahead for the surgery in this case, if the woman is really not capable of understanding what is likely to happen if she doesn't have the surgery.

I agree that uterine cancer can usually be cured by surgery alone if operated on in time.

The alternative is to allow it to spread, causing bleeding and pain over a long period of time.

If this woman has severe learning difficulties and a phobia of hospitals and needles, her subsequent deterioration and death will be physical and mental torture for her, for an indeterminate lenth of time.

I don't think anyone would want to allow her to "choose" this option.

It's not just one procedure that will be carried out by force, though. It's a whole series of physical assaults. Anyone else may think it was better to have surgery than to have a unpleasant death, but the prospect of keeping her in hospital by force, carrying out surgery by force, and giving post-operative procedures by force is horrific.

The Christie Hospital in Manchester uses complementary medicine to help people with needle phobia, btw (quite a few chemo patients are affected). Think they use massage. Wonder whether anyone has thought of trying to ask this lady if she'd consider something like that?

And to talk of not 'allowing' her to choose really does smack of discrimination against people with LDs. They are not children. There should be no question of 'allowing' or 'not allowing'.

I think its a combination of psychartric and learning difficulties. There are certain circumstances where adults without learning difficulties are forced to have treatment.

Should someone with an extreme phobia be allowed to die? Should we respect the wishes of people to commit suicide? Many people are sectioned under the mental health act and forced to have treatments. For example a severely depressed person may well be given ECT if medication has failed.

Surely the easiest way round this is to give her kitchen table a good scrub down with some milton and a whacking dose of pre and post op antibiotics and do it at home ! at least she wont get any hospital aquired infections.