Terminal illness in a psychiatric patient--issues and ethics.

A woman with paranoid psychosis and terminal breast cancer refused palliative radiation, demanding pain-killers and permission to leave hospital to go into the mountains and die on her own. Was it ethical to allow her to do so, or should a court order have been sought to impose hospital treatment on her? Should she have been persuaded to accept hospital care? When do those in charge deem a terminally ill patient unable to understand the issues, and dictate treatment? Our aim in this article is to highlight a number of ethical matters regarding patient care, as well as to try and determine the role a hospice should play with regard to the terminally ill patient with associated psychiatric disorder.