A Case Vignette and Review of Maladaptive Denial and Related Ethical Issues

Merideth Prevost,Natalie M Salas,Cynthia Geppert,Holly Fleming,Wendy H Gerstein

doi:10.3844/amjsp.2016.3.6

Abstract

Maladaptive denial is a pathological reaction to the symptoms, signs or diagnosis of a physical illness. The dominant response is persistent denial of having the physical disorder. Maladaptive denial typically results in the inability of the patient to provide informed consent to treatment due to the refusal to acknowledge an underlying disease process. This pathologic behavior exposes the affected individual to a significantly higher risk of serious physical illness or death. This paper describes a patient with maladaptive denial to his diagnosis of stage IV Non-Hodgkin's lymphoma which results in his death. The authors de fine the disorder, discuss the common ethical issues that arise when taking care of patients with maladaptive denial and summarize the recommended management.

Highlights

In the summer of 2015, a 58 year old male was admitted to the New Mexico VA Hospital in Albuquerque, NM with stage IV Non-Hodgkin’s lymphoma
At the time of admission to the inpatient medicine teaching service, the patient was oriented to place and time and could reasonably discuss current events. He appeared to have decisional capacity, he was not delirious and he had no prior history of psychiatric illness
When code status was discussed the patient stated “I want everything done.”Chemotherapy informed consent discussions were not possible because the patient was unwilling to acknowledge that he had cancer and would not discuss the potential adverse outcomes of treatment

Summary

Introduction

In the summer of 2015, a 58 year old male was admitted to the New Mexico VA Hospital in Albuquerque, NM with stage IV Non-Hodgkin’s lymphoma. Imaging revealed right retroperitoneal adenopathy with abscess, interval progression of the lymphadenopathy, inferior vena cava compression and new skeletal lesions. He underwent abscess drainage, treatment, and biopsy. The biopsy was diagnostic for Stage IV Non-Hodgkin’s lymphoma. At the time of admission to the inpatient medicine teaching service, the patient was oriented to place and time and could reasonably discuss current events. He appeared to have decisional capacity, he was not delirious and he had no prior history of psychiatric illness

Need Time to Absorb this Information

Just Need to Eat Better and My Blood Counts Will Go Up

Think I Need a Vacation from Albuquerque

Conclusion