OU on the BBC: Inside the Ethics Committee 2010 - Mentally ill and refusing surgery

Joan Bakewell is joined by a panel of experts to discuss the real life case of John who has schizophrenia and is being treated in a low secure mental health unit. Two months ago, he was transferred from prison where he had been refusing psychiatric treatment and was very psychotic.

In an effort to improve his mental health, John was transferred to the unit so that the forensic psychiatrist there could treat him, without his permission, under the Mental Health Act. Since then, John has received regular injections and his psychotic symptoms have mainly subsided.

Tumour

With John's mental health improved, his forensic psychiatrist is keen for him to address another health problem - his hoarse voice. John agrees to see an ENT surgeon who, on examining his throat, is alarmed to discover that he has an advanced tumour on his voice box which is pressing on his airway.

Given its advanced state, the best option for John is to remove his voice box and fit a valve in his neck, through which he would be able to draw in air and generate sound for speech. John agrees to the operation and a date is set for ten days time.

Conspiracy

John is worried about the operation but accepts that he needs it. However, a day or so later he changes his mind; he starts saying that the operation is an elaborate conspiracy to kill him.

Without surgery, John has only a few weeks to live. What should the surgeon do? Should he operate without his consent? It might save John's life, but would it be in his best interests? The surgeon has had patients, without mental health problems, who chose to risk their lives rather than have their voice boxes removed.

Joan Bakewell is joined by her panel of experts to discuss the complex ethical issues arising from this case.