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2017年11月17日，英国医学会《英国医学杂志》在线发表新闻报道：拒绝乳腺癌诊断的女性可以不经其同意进行手术。 英国高等法院法官裁定，一位66岁偏执型精神分裂症女性可以被全身麻醉下不经其同意进行乳腺癌手术。 法官基恩先生宣布，一位被称为JT的女士否认自己患有癌症，但是缺乏自行决定是否接受治疗的能力。 法官授权北英格兰中部大学医院“在全身麻醉下通过手术切除左侧乳腺导管腺癌”合法并符合JT的最大利益。 法官称，25年前被诊断患有偏执型精神分裂症的JT女士，坚信她的乳房肿块是囊肿，“与她接触过的会诊医生和临床医生都是演员或冒名顶替者”。 JT住在社区并得到社区精神科护士的帮助。如果JT需要被强制带去医院做手术，法官称批准任何必要的强制或剥夺自由。 法官于10月12日作出判决，定于10月17日至11月2日进行手术，但是判决现在才被公布。 JT最初于2017年2月被其全科医生转诊至公立乳腺医疗机构，但是错过了3次预约。6月，她的全科医生迫切地将她转诊，外科会诊医生对其进行检查，并诊断她的左乳房有恶性肿瘤，经超声和活检确认。 6月后期，在她的兄弟陪同下，她看了这位外科医生，处方了一个疗程的阿那曲唑，尝试缩小肿瘤。后来她的兄弟称，她拒绝服药。 8月，她复查了超声波扫描，暂定9月进行手术，但是她拒绝接受手术或参加术前检查。 后来，她告诉护士，陪同她的兄弟不是她真正的兄弟，而且他告诉她，她乳房里的肿块是一个控制盒。此后，医院决定向法院起诉。 曾经治疗她18年的精神科医生告诉法庭，他相信她权衡与自己病情相关信息的能力障碍。“她认为她未患乳腺癌，她的敌人们阴谋假装她有病，他们就可以对她进行一些手术或治疗。她坚信她被冒牌的假兄弟带到假医院看了假医生，而且这是阴谋的一部分。” 她的会诊医生同意她无法了解有关风险和获益的信息。临床医生与她的兄弟和社区护理人员决定，由于乳房切除术对她而言太痛苦，故她应该接受在一天内就能搞定的保乳手术。 BMJ. 2017 Nov 17;359:j5358. Woman who rejected breast cancer diagnosis may undergo surgery without her consent. Dyer C. The BMJ. A 66 year old woman with paranoid schizophrenia may be put under general anaesthetic and have surgery for breast cancer without her consent, a High Court judge has ruled. Mr Justice Keehan declared that the woman, referred to as JT, who denied that she had cancer, lacked the capacity to decide for herself whether to have the treatment. He granted University Hospitals of North Midlands NHS Trust "an order that it is lawful and in JT's best interest to undergo surgical removal by wide local excision of ductal adenocarcinoma of her left breast under general anaesthetic." JT, who was diagnosed with paranoid schizophrenia more than 25 years ago, believed that the lump in her breast was a cyst and that "the consultants and clinicians, with whom she has come into contact, are actors or impostors," the judge said. JT lives in the community and is supported by a community psychiatric nurse. If she needed to be restrained to take her to the hospital for surgery, Keehan said he authorised any restraint or deprivation of liberty that was necessary. He delivered his judgment on 12 October, with surgery scheduled for 17 October to 2 November, but the judgment has only now been published. JT was initially referred to the trust's breast care services in February 2017 by her GP but missed three appointments. Her GP referred her urgently in June, when she was seen by a locum consultant surgeon who diagnosed a malignant lump in her left breast, confirmed by ultrasound and biopsy. Later in June she saw the locum surgeon, accompanied by her brother, and was prescribed a course of anastrozole to try to shrink the tumour. Later her brother notified the breast team that she had refused to take the drug. She had a repeat ultrasound scan in August and was tentatively scheduled for surgery in September but she refused to have the surgery or attend a pre-operative assessment. Later she told a nurse that the brother who accompanied her was not her real brother, and that he had told her that the lump in her breast was a control box. After this, the trust decided to take the case to court. The psychiatrist who had treated her for 18 years told the court he believed her ability to weigh up information relating to her condition was impaired. "Her understanding is that she does not suffer from breast cancer, and it is a conspiracy on the part of her enemies to pretend that she had the illness so they can enforce some procedure or treatment on her of their own making. She believes she had been taken to a fake hospital by a fake impostor brother who was seen by fake doctors and this is all part of a conspiracy." The consultant surgeon who saw her agreed that she was unable to understand the information relevant to risks and benefits. The clinicians, along with her brother and the community nurse practitioner, decided that a mastectomy would be too distressing for her and that she should have breast conserving surgery, which could be done as a day case. PMID: 29150422 DOI: 10.1136/bmj.j5358 |
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