I really appreciate the article by Ms Young and Dr Everett [BCMJ 2015;57:434-437 [3]] and the simplified algorithm for ethical decision making. All too often we are faced with patients who are dealing with mental illness or drug abuse, and it becomes tricky when patients refuse medical treatment that we strongly believe can improve or prolong their lives. Are they making a bad decision due to their mental disorders? Or is it because their judgement of risks and benefits differs from ours? The article’s algorithm is easy to read and apply, and will also serve as a useful tool when I teach medical students about these types of situations.

I also think that an in-service for nurses and allied health care professionals on this topic should be made available. Perhaps it already is? If a patient with a history of mental health issues (especially drug abuse) becomes difficult or refuses treatment, I am often asked to have the patient certified so that medical treatment can be forced. I then explain the (in)appropriateness of certification and what we can legally do with certified patients, but an information session may help to decrease the number of these requests.

And, of course, I always appreciate the good services of psychiatry to help us determine competency. Thanks again for the informative article.
—Alan Tung, MD
Resident Physician, PGY-1
UBC Department of Anesthesiology, Pharmacology, and Therapeutics