Schizophrenia and Violent Behavior: A Case Study of ST's Refusal of Medical Care

ST is a 45-year-old woman who has a history of schizophrenia and violent behavior. Although she can occasionally respond appropriately to clinicians' questions, she has been hospitalized multiple times in various organizations in the city for swallowing sharp objects which require surgical removal. ST typically objects to these surgeries with great fear and anxiety, often requiring forced anesthesia. She has experienced restraints during her encounters with clinicians, including physical, chemical, and legal means. ST has a history of not keeping post-hospitalization follow-up appointments and cannot adhere to prescribed medications without close supervision. Recently, ST underwent an initial surgery to extract a pen she had swallowed and had been recovering well until she expressed her refusal to undergo any more surgeries. Dr. L, a second-year surgery resident physician, approached ST and sat with her, explaining that she would need at least one more surgery to check for bowel perforation. ST expressed her despair, feeling as though her decisions did not matter and no one cared about what she wanted.