RT Journal Article SR Electronic T1 Medical mismanagement or public vacillation? JF Journal of Medical Ethics JO J Med Ethics FD BMJ Publishing Group Ltd and Institute of Medical Ethics SP 179 OP 181 DO 10.1136/jme.7.4.179 VO 7 IS 4 A1 P N Bamford YR 1981 UL http://jme.bmj.com/content/7/4/179.abstract AB Ian Kennedy extols the virtues of self-determination by patients: they should make their own decisions about medical treatment after being given advice by their doctors; for doctors to make such decisions on their patients' behalf is authoritarian and unacceptable (I). I present a case where, despite thorough consultation and counselling, the decisions made by the patient and supported by her doctors were found to be consistently inappropriate to her changing lifestyle.