"See you next week--unless I'm dead"

The common law, statutes and professional codes of medical and health care uphold the right of competent patients to refuse treatment that they have been advised is in their best medical interests, recognising that they have the right to decide whether such medical advice aligns with their self-determined, global interests. But sometimes, there can be ambivalence within the treating practitioner's mind as to what the patient's best medical interests consist of in the first place. The case presented here of chronic mental health problems illustrates this ambivalence or clinical equipoise, and raises clinical, conceptual, ethical, legal and conscience issues for individual practitioners and the wider community. The case evades clarity and consensus over the doctor's legal obligations, but the complex emotional, psychodynamic, attachment and existential issues that it raises also render any ethical analysis ultimately unsatisfactory, unless it be agreed that some people can only be helped by suspending judgment and treatment, and by just being there.