Sir: We are gratified that the case we described (Sandford et al, Psychiatric Bulletin, June 2001, 25, 206-280) stimulated such interest and controversy. However, much of Dr Adshead's commentary (Psychiatric Bulletin, October 2001, 25, 374-375) related to the general issue of deceiving patients and failed to take into account the particular features of the case that made it exceptional.
First, the case was not ‘ordinary’ insofar as we were dealing with a person with a pervasive developmental disorder whose communication and cognitive difficulties lay at the heart of this dilemma. Adshead wonders if it had been possible to talk to the patient about moving over a long period. As we described, the many previous attempts to do this had caused extreme anxiety that had precipitated assaultative behaviour and led to the potential placements falling through. Adshead appears to assume that the communication issues for our patient were the same as for the non-autistic majority, unfortunately this is not supported by the research evidence.
Second, Adshead was incorrect to describe this as a forensic case; the patient was detained under a civil section and had been for many years inappropriately placed in a forensic facility, hence the impetus to move her into an autistic friendly environment.
Third, again as detailed in the case, her suspicions around the time issue are unfounded, planning around the move took many months of careful negotiation. Fourth, at no point was false information given to the patient (i.e. the patient was not told a lie), we rather withheld information. Last, the concept of human dignity is now widely used in a variety of complex bioethical debates from care of children with behavioural disorders through palliative care to the patenting of DNA and xenotransplantation.