ror.org/05fq50484
Résumés
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
Parties annexes
Bibliography
- 1. Kornischka J, Schneider F. Delusion of pregnancy. A case report and review of the literature. Psychopathology. 2003;36(5):276-8.
- 2. Government of Ontario. Health Care Consent Act, 1996. SO 1996, c 2, Sch A, S 4 (2).
- 3. Government of Ontario. Mental Health Act, RSO 1990. c. M.7, s. 20
- 4. Tiihonen J, Lönnqvist J, Wahlbeck K, et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet. 2009;374(9690):620-7.
- 5. Smith DJ, Langan J, McLean G, Guthrie B, Mercer SW. Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study. BMJ Open. 2013;3(4):e002808.
- 6. Irwin KE, Henderson DC, Knight HP, Pirl WF. Cancer care for individuals with schizophrenia. Cancer. 2014;120(3):323-34.
- 7. Tilbrook D, Polsky J, Lofters A. Are women with psychosis receiving adequate cervical cancer screening? Can Fam Physician. 2010;56(4):358-63.
- 8. Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M. Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet. 2009;373(9661):408-15.
- 9. Shefer G, Henderson C, Howard LM, Murray J, Thornicroft G. Diagnostic overshadowing and other challenges involved in the diagnostic process of patients with mental illness who present in emergency departments with physical symptoms--a qualitative study. PLoS ONE. 2014;9(11):e111682.