Ethics Grand Rounds

A refusal of a life-saving hysterectomy due to a delusion of pregnancy

Monday, December 6, 2021 | 12-1pm | Virtual

Presenters:  Julie Maggi, MD, FRCPC, staff psychiatrist Unity Health in Toronto; Marnina Norys, PhD, Ethicist, Humber River Hospital; Eliane Shore, MD, MSc, FRCSC, Staff Physician, Division of Gynaecologic Surgery and Pelvic Medicine, Unity Health Toronto; Michael Szego, PhD, MHSc, Senior Director, Centre for Clinical Ethics, Unity Health Toronto

This ethics grand rounds will feature a case discussion involving a postmenopausal woman in her 50s who was diagnosed with Grade 1 endometrioid Adenocarcinoma. A unique feature of this case was that she declined a proposed hysterectomy due to long held delusion of pregnancy associated with schizophrenia. Capable patients have the right to refuse proposed treatments. In this case, the patient was reasonably well functioning considering the nature of her psychiatric illness, although there was a consensus that the patient’s delusions distorted her ability to appreciate the risks of accepting or refusing surgery. In this presentation, we will discuss the potential harms and benefits of surgery and the careful stepwise approach we adopted in an attempt to support the patient’s decisional capacity as a necessary step prior to attempting any surgical procedures. We will also discuss the positive impact of interdisciplinary collaboration with various healthcare providers including those, such as her family physician, who have maintained a long standing relationship with the patient.

Goals and Objectives

1) To identify the 2-part test for capacity and how it applies in this case

2) To learn about the Mental Health Act and how it can be used when patients are at risk of harming themselves

3) To discuss the ethics of potentially forcing a procedure on an unwilling but incapable patient

CME Accreditation — Physician attendees will be eligible to receive one Section 1 Continuing Professional Development (CPD) credit as certified by the Royal College of Physicians and Surgeons of Canada. Links for providing feedback and registering for CME credit will be available live in the session.

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