I am troubled by Douglas P. Olsen's statements in "Unwanted Treatment" (Ethical Issues, September 2007). I would certainly agree that a clinician may override a patient's decision if the patient is mentally incompetent, is a minor, or if the decision may cause harm to others. However, he writes that a "decision to override a patient's wishes might also result if the clinician believes that what the patient wants isn't in the patient's best interest and could result in irreparable harm or even death." This assertion is paternalistic and dismissive of the patient's autonomy and self-determination. Cases involving adolescents must be evaluated on a case-by-case basis, but ethicists generally consider self-determination above all other ethical principles. The right to make decisions should be protected unless a patient is deemed incompetent.

Betty Robinson Sorrentino, MS, RN, CNS

San Luis Obispo, CA