Abstracts
Abstract
A 56-year-old postmenopausal woman (FB) was diagnosed with Grade 1 endometrioid adenocarcinoma but was refusing a hysterectomy. The patient understood she had cancer and understood treatment was required to treat the condition. However, due to a well-entrenched delusion of pregnancy associated with a diagnosis of schizophrenia, FB believed the surgery recommended by her gynecologist would harm the fetus she believed to be developing inside her womb. FB was deemed incapable of consenting to surgery due to her pregnancy delusion, which meant that the procedure could be performed with consent from a substitute decision maker (SDM). In this paper, we describe our team’s approach to the presenting moral dilemma consisting of a choice between forcing surgery on an unwilling patient or allowing her to die of a treatable illness.
Keywords:
- delusion of pregnancy,
- psychiatry,
- informed consent,
- capacity,
- oncology,
- interdisciplinary collaboration
Résumé
Un adénocarcinome endométrioïde de grade 1 a été diagnostiqué chez une femme ménopausée de 56 ans (FB), qui refusait une hystérectomie. La patiente comprenait qu’elle avait un cancer et qu’un traitement était nécessaire pour soigner sa maladie. Cependant, en raison d’un délire de grossesse bien ancré associé à un diagnostic de schizophrénie, FB pensait que l’intervention chirurgicale recommandée par son gynécologue nuirait au foetus qu’elle croyait en train de se développer dans son utérus. FB a été jugée incapable de consentir à une intervention chirurgicale en raison de son délire de grossesse, ce qui signifie que l’intervention pouvait être pratiquée avec le consentement d’un mandataire spécial. Dans ce texte, nous décrivons l’approche de notre équipe face au dilemme moral présenté, qui consiste à choisir entre imposer une intervention chirurgicale à une patiente réticente ou la laisser mourir d’une maladie traitable.
Mots-clés :
- délire de grossesse,
- psychiatrie,
- consentement éclairé,
- capacité,
- oncologie,
- collaboration interdisciplinaire
Appendices
Bibliography
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