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Bruce is a 69 year old retired gentleman. He lives at home with his wife Betty, and together they have three adult children. Bruce is a Vietnam veteran, and as a consequence of his active duty during the war he has developed severe post-traumatic stress disorder and depression. He suffers with hypertension and hypercholesterolemia, but has repeatedly declined any treatment for any of these conditions. Bruce also has a lump on the right underside of his chin that is about the size of a golf ball. Bruce’s wife reports that this lump had been present for many months but despite the fact that it has turned into an open wound with an offensive exudate, Bruce had refuses to seek treatment for it. In recent weeks Bruce has developed symptoms suggestive of an infective illness. He has complained of generalised malaise, muscle aches and pains and an elevated temperature with occasional rigors. Despite the best efforts of Betty and the children, Bruce has refused to seek medical attention for these symptoms even as his condition deteriorated. Eventually Bruce became so weak and dehydrated that he was no longer able to refuse Betty’s efforts to have him see a doctor; with the assistance of their children Betty manoeuvred him into the car and took him to hospital. On admission to the hospital Bruce was noted to be hypotensive, tachycardic and febrile. His level of consciousness fluctuated, and was often only minimally responsive. Concerned that he may not be able to adequately protect his airway, Bruce was transferred to the high dependency unit where he could be closely monitored. Bruce was diagnosed with septicaemia resulting from the open wound under his chin

Bruce is a 69 year old retired gentleman. He lives at home with his wife Betty, and together they have three adult children. Bruce is a Vietnam veteran, and as a consequence of his active duty during the war he has developed severe post-traumatic stress disorder and depression. He suffers with hypertension and hypercholesterolemia, but has repeatedly declined any treatment for any of these conditions. Bruce also has a lump on the right underside of his chin that is about the size of a golf ball. Bruce’s wife reports that this lump had been present for many months but despite the fact that it has turned into an open wound with an offensive exudate, Bruce had refuses to seek treatment for it. In recent weeks Bruce has developed symptoms suggestive of an infective illness. He has complained of generalised malaise, muscle aches and pains and an elevated temperature with occasional rigors. Despite the best efforts of Betty and the children, Bruce has refused to seek medical attention for these symptoms even as his condition deteriorated. Eventually Bruce became so weak and dehydrated that he was no longer able to refuse Betty’s efforts to have him see a doctor; with the assistance of their children Betty manoeuvred him into the car and took him to hospital. On admission to the hospital Bruce was noted to be hypotensive, tachycardic and febrile. His level of consciousness fluctuated, and was often only minimally responsive. Concerned that he may not be able to adequately protect his airway, Bruce was transferred to the high dependency unit where he could be closely monitored. Bruce was diagnosed with septicaemia resulting from the open wound under his chin

Bruce is a 69 year old retired gentleman. He lives at home with his wife Betty, and together they have three adult children. Bruce is a Vietnam veteran, and as a consequence of his active duty during the war he has developed severe post-traumatic stress disorder and depression. He suffers with hypertension and hypercholesterolemia, but has repeatedly declined any treatment for any of these conditions. Bruce also has a lump on the right underside of his chin that is about the size of a golf ball. Bruce’s wife reports that this lump had been present for many months but despite the fact that it has turned into an open wound with an offensive exudate, Bruce had refuses to seek treatment for it. In recent weeks Bruce has developed symptoms suggestive of an infective illness. He has complained of generalised malaise, muscle aches and pains and an elevated temperature with occasional rigors. Despite the best efforts of Betty and the children, Bruce has refused to seek medical attention for these symptoms even as his condition deteriorated. Eventually Bruce became so weak and dehydrated that he was no longer able to refuse Betty’s efforts to have him see a doctor; with the assistance of their children Betty manoeuvred him into the car and took him to hospital. On admission to the hospital Bruce was noted to be hypotensive, tachycardic and febrile. His level of consciousness fluctuated, and was often only minimally responsive. Concerned that he may not be able to adequately protect his airway, Bruce was transferred to the high dependency unit where he could be closely monitored. Bruce was diagnosed with septicaemia resulting from the open wound under his chin

CASE STUDY SCENARIO

Bruce is a 69 year old retired gentleman. He lives at home with his wife Betty, and together they have three adult children. Bruce is a Vietnam veteran, and as a consequence of his active duty during the war he has developed severe post-traumatic stress disorder and depression.  He suffers with hypertension and hypercholesterolemia, but has repeatedly declined any treatment for any of these conditions. Bruce also has a lump on the right underside of his chin that is about the size of a golf ball. Bruce’s wife reports that this lump had been present for many months but despite the fact that it has turned into an open wound with an offensive exudate, Bruce had refuses to seek treatment for it.

In recent weeks Bruce has developed symptoms suggestive of an infective illness. He has complained of generalised malaise, muscle aches and pains and an elevated temperature with occasional rigors. Despite the best efforts of Betty and the children, Bruce has refused to seek medical attention for these symptoms even as his condition deteriorated.

Eventually Bruce became so weak and dehydrated that he was no longer able to refuse Betty’s efforts to have him see a doctor; with the assistance of their children Betty manoeuvred him into the car and took him to hospital. On admission to the hospital Bruce was noted to be hypotensive, tachycardic and febrile. His level of consciousness fluctuated, and was often only minimally responsive. Concerned that he may not be able to adequately protect his airway, Bruce was transferred to the high dependency unit where he could be closely monitored.  Bruce was diagnosed with septicaemia resulting from the open wound under his chin.

After a series of investigations it was determined that the infected lump under Bruce’s chin was a malignant tumour. The team caring for Bruce formed the opinion that surgery to remove the tumour was the most appropriate course of action.  The surgeon who was to perform the operation sought Bruce’s consent for the operation. Bruce’s fluctuating level of consciousness made this quite difficult, although in a moment of lucidity he clearly stated… “I don’t want any operations – I’d rather die”.  Shortly after this, with Betty’s consent, the surgery went ahead, and the entire tumour was successfully removed.  Bruce’s post-operative recovery was relatively uneventful and his sepsis resolved.  However he was left with a very large and disfiguring scar and some ongoing difficulties with swallowing. When he was eventually discharged home, Bruce became increasingly angry that he had been operated on without his consent.  Bruce now wishes to sue the surgeon who performed the operation.

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