Usurping Patients' Prerogatives

To the Editor: The general principle put forward by Kassirer (April 14 issue)* is sound and well expressed. The cases he presents, however, do not illustrate well what he is trying to say. In the first case the psychiatrist and internist, however wrongly, honestly believed that the risk of giving lithium outweighed the possible benefit. Evidently, there was a good deal of discussion in which the patient and her family actively participated, but the doctors remained unconvinced (at least until a nephrologist was consulted). How can a doctor be obliged to prescribe treatment he or she believes to be harmful? . . .