What question did this study set out to answer?

To review the clinical standards and diagnostic approaches for determining whether an impaired patient possesses the decision-making capacity to refuse a life-saving medical intervention.

October 31, 2007New England Journal of Medicine

Assessment of Patients' Competence to Consent to Treatment

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To review the clinical standards and diagnostic approaches for determining whether an impaired patient possesses the decision-making capacity to refuse a life-saving medical intervention.
Examined a clinical case of a 75-year-old woman with diabetes, vascular disease, depression, and cognitive decline who refused a life-saving below-the-knee amputation.
Evaluated medical and psychiatric criteria used by physicians to formally assess competence and capacity in clinical decision-making.
Determining decision-making capacity requires assessing four specific abilities: communicating a consistent choice, understanding relevant clinical information, appreciating the medical circumstances and consequences, and manipulating information rationally.
Reversible psychiatric and metabolic contributors to impaired judgment, including major depression and progressive confusion, require prompt identification and treatment before concluding that treatment refusal is fully competent.

Implication

Clinical review examines assessment of decision-making capacity in patients refusing life-saving care, highlighting structured evaluation of cognitive appreciation.

Abstract

A 75-year-old woman has type 2 diabetes mellitus, peripheral vascular disease, and a gangrenous ulcer of her left foot. A below-the-knee amputation is recommended, but she declines, saying that she has lived long enough and wants to die with her body intact. Her internist is concerned about her increasing confusion over the past year and notes that she appears to be depressed. How should her physician determine whether her decision is competent?

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Cite This Study

Paul S. Appelbaum (2007) studied this question.

synapsesocial.com/papers/6a0ac5f64a081dac3aac985d https://doi.org/10.1056/nejmcp074045

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Implication

Clinical review examines assessment of decision-making capacity in patients refusing life-saving care, highlighting structured evaluation of cognitive appreciation.

Assessment of Patients' Competence to Consent to Treatment

Key Points

Implication

Abstract

Discussion

Cite This Study

Assessment of Patients' Competence to Consent to Treatment

Key Points

Implication

Abstract

Discussion

Cite This Study

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