This Case Study describes a patient with oliguric kidney failure who denied his need for hemodialysis even when experiencing symptoms of volume overload. Although any adequate analysis of the case will address a hotly debated issue in clinical ethics, namely, whether denying a diagnosis or prognosis renders a patient incapable of medical decision-making, the focus of this article is elsewhere. Specifically, I raise the concern that no matter which answer we provide to the prior question, the circumstances in which it arises constitute a form of second-order injustice when patient disbelief is a result of justified distrust of medical providers.
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