Foreign body within the upper esophagus of a patient not consenting to surgical treatment – case report and legal proceedings in light of current case law

Abstract

<b><br>Introduction:</b> Patients intentionally inserting foreign bodies into the lumen of their gastrointestinal tract usually aim at achieving certain benefits, such as postponement or avoidance of punishment.</br> <b><br>Aim:</b> In view of the ever-increasing number of proceedings (including criminal proceedings) against health care professionals, the authors carried out a review of the available literature on: medical actions undertaken in cases of foreign bodies within the esophagus, current legislation and jurisprudence as practiced in the Republic of Poland within the context of model legal proceedings in cases involving patients raising doubts about being fully conscious and not consenting to necessary treatment.</br> <b><br>Case report:</b> The article presents a case of a patient with an esophageal foreign body who had not consented to the proposed surgical treatment. Doubts as raised within the otorhinolaryngological team with regard to the patient’s state of consciousness were not dispelled as the result of psychiatric consultation. Following a meticulous analysis of the current jurisprudence of the Polish judicial system and obtaining a court’s permission to intervene, the procedure (esophagoscopy with removal of esophageal foreign body) was performed. After exclusion of any life-threatening complications, the patient was transferred to the Psychiatric Department.</br> <b><br>Conclusions:</b> In the current state of the law, performing a procedure to remove a foreign body from the esophagus without prior court approval could qualify as a violation of patient’s rights. In such case, legal liability of the physician would arise regardless of the fact that the patient would have received care in accordance with the current medical knowledge and practice.</br>