Refusal of surgery: A case-based review of ethical and legal principles behind informed consent in Canada

摘要

Respect for patient autonomy is an important tenet to the ethical practice of medicine. However, situations arise where there is a strong medical indication for life-prolonging surgery, but the patient refuses, even after a thorough discussion of benefits and harms of the intervention. If the patient is of sound mind, medical interventions that respect the patient’s choice should be followed. If the patient has suspected, or known, cognitive dysfunction, the treatment path is less clearly defined. Urologists rarely encounter clinical scenarios where there is discordance between what is medically indicated and what is chosen by the cognitively-impaired patient. Given the rarity of this scenario, urologists may be underprepared about how to ethically and compassionately manage these patients. In this article we present a case and review the ethical and legal principles that should guide surgeons. Some details of this case have been changed to preserve patient confidentiality.