Involuntary treatment is a familiar concept that usually brings to mind psychiatrists hospitalizing mentally ill patients and administering pharmacological remedies. However, psychiatric patients may also have medical problems that require invasive, surgical treatments, many of which carry a risk of morbidity and mortality. The author describes a case involving a 62-year old female patient who is a retired nurse and a resident of an adult home. The patient’s psychiatric history is discussed, as well as her multiple, serious medical problems. When the patient would not cooperate or consent to invasive, life-saving surgery, a dilemma presented itself for those responsible for her care. The dilemma involved how to balance the obligation to treat the patient while at the same time respecting her autonomy. The author recommends that professionals who work with psychiatric patients assist them in being proactive about their health care. Obtaining an advance directive of the patients’ wishes concerning possible future treatment is suggested. This may be possible with patients whose capacity to make decisions fluctuates with the state of their illness, rendering them more lucid at certain times. References