[Joint decision making--a challenge. A psychiatric patient with end-stage cancer refuses antitumor treatment]

Decision making concerning patients with end stage cancer is a challenging process. Since quality of life is a very important issue for patients with short-term life expectancy, benefits of antitumor therapy and possible negative side effects have to be considered carefully. The patient's desires play a pivotal role in the final decision. Informed consent becomes even more difficult when the competence of a patient in choosing treatment is questionable. In this case report, a 60 year old female patient with exulcerating breast cancer, brain metastases and long-term untreated schizophrenia refuses antitumor treatment. How can the palliative care team make the best possible decision on her behalf? Medical, ethical and legal aspects are discussed.