Virtuous physicians always asses the decision making capacity and the competence of their patients to make sure they have adequate capacity to make their own decisions, especially for patients who refuse specific treatment, have mental illness, or have specific factors that impair their ability to make decision( _1).
What make a patient competent to make a decision? , and do depressed people lose their competence and their decisional capacity? . Depression is a common side effect of cancer (2), and cancer treatment require a lot of important decisions that patients need to make which are very significant in determining their future, and respecting patient will is fundamental in term of autonomy, but what if the patient refuse the treatment, if the doctor consider him as non-autonomous he also will think about his duty in non-maleficence and about his responsibility in supporting and respecting patient wishes.
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If a patient refuse the treatment in reflection to his desire of death, low self-esteem , thinking that life is not worth living, in that case we can say depending in autonomy definition that they are non-autonomous.(3) in addition Depressed patients usually undervalue the future risks from refusing the treatment, so they lose the ability in reasoning process and according to ucsd reasoning is one of the main elements for decision-making capacity (4) .However , addressing them as non-autonomous come with high price , because first we will ignore patient Preferences , and the harm of enforcing the patient to take medications against its will , might exceed the harm of the patient without medications. (5) that is why deciding if a patient is competent or not should be evaluated in proportion to