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Ethical dilemmas in drug treatments

St Charles Hospital, Exmoor Road, London W10 6DZ

Jeanette Smith, Senior Registrar

Fromeside Clinic, Blackberry Hill, Bristol BS16 1ED

Gwen Adshead, Lecturer

Department of Forensic Psychiatry, Institute of Psychiatry, De Crespigny Park, London SE5 8AF

A 45-year-old woman with a long history of schizo-affective symptoms associated with disruptive and antisocial behaviour refused to cooperate with out-patient treatment and particularly medication, having developed a strong distrust of psychiatrists. After discussions with the multidisciplinary team, the psychiatrist agreed to share treatment decisions with the patient and accepted her refusal of medication. This course of action is not always comfortable for professionals, especially when a patient challenges clinical judgement. However, this case illustrates how, by adopting a less paternalistic approach, the therapeutic alliance developed and, most importantly, the patient's health improved. The scenario described raises similar issues to those explored in the play Whose Life is it Anyway?