Remember, any person, including one facing emergency surgery, still has a right to know beforehand what is likely to be found and how the surgeon will probably want to deal with it. Any person also has a right to set limits on what he or she will permit. We discussed this earlier in this chapter. For example, the emergency patient described above may not wish to have a colostomy (bowel emptying through an opening on the abdominal wall). He or she has the right to refuse a colostomy and also the right to know what could happen because of such a refusal. Refusal may not create a problem if the surgeon can relieve the obstruction by some other means, such as removing or bypassing the blocked section of bowel. However, if this is not possible, the person’s refusal to have a colostomy could mean his or her death within a few days of the operation. Knowing this, he or she is still entitled to refuse a colostomy. No surgeon has the right to override an adult patient’s refusal to agree to any procedure, even though that procedure could be temporarily life saving. You know what’s best for you. You know what you can and can’t handle. You may know that you would rather die than have some drastic temporarily life saving treatment. Hold on to what is right for you.

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There are some cases when all efforts to make a pre-operative diagnosis are either unsuccessful or prevented by the urgency of the situation. Here is an example of the first type of situation. A person has had persistent abdominal pain and weight loss, for which no cause can be found on clinical examination and extensive tests. Cancer is suspected but cannot be proved. An exploratory operation may be recommended. In this case the person must either be prepared to have two major abdominal operations within a few days of each other, or agree to the surgeon immediately performing whatever operation seems best once the diagnosis is made. Fortunately, it is rarely so difficult to make a diagnosis. If such an exploratory operation is recommended to you I suggest that you ask for a second opinion before agreeing to it. Another doctor may be able to think of a way of making the diagnosis without operating.

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