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Endgames Case Report

Caring for a woman with intellectual disabilities who refuses clinical diagnostic investigations

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.f7645 (Published 03 January 2014) Cite this as: BMJ 2014;348:f7645

Rapid Response:

Re: Caring for a woman with intellectual disabilities who refuses clinical diagnostic investigations

This was a very informative article as I was not aware of all the services that were available to help patients who had such difficulties as the patient in this case. Thank you for that.

I am however curious to understand how the decision was reached that it was in this patient's best interests to have upper and lower GI endoscopies. If she was not going to be treated anyway and died the following year, how was it in her best interests to have such an uncomfortable procedure? Were surgeons consulted in this "best interests" meeting? Was there a discussion about how the result of the endoscopies would improve her quality of life or clinical outcome? If she was going to be left to die anyway, why spend so much time, human and financial resources on procedures that did nothing to improve or inform the care she eventually received? Insight to this will be greatly appreciated.

Competing interests: No competing interests

08 January 2014
Uruakanwa Ekwegh
Medical Doctor
East Lancashire NHS Trust
Pendle Community Hospital, BB9 9SZ