Adolescent Objection to Surgery: A Careful Evaluation of Current and Future Interests

This clinical report presents an ethics consultation regarding a 17-year-old adolescent, Vanessa “Venus” Marigold, who had an emergent, life-threatening cardiac myxoma. Despite parental consent and the imminent risk of death, the patient refused the lifesaving surgery, stating, “I just don’t want it.” The case presented a profound ethical dilemma: respect for a patient’s developing autonomy against a professional obligation to protect the patient’s right to an open future. An ethics consultation was initiated to assess the dilemma and provide recommendations. The team ultimately recommended a non-ideal care plan—a one-day delay of the emergent surgery—to secure the patient’s assent and preserve the therapeutic relationship. This delay successfully reduced the patient’s situational anxiety and allowed her to agree to the procedure the following day, despite the risks involved. This article explores the dilemma, ethics principles, and eventual trade-off in the non-ideal care plan.