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Challenges in Capacity and Decision Making

Patient rights include the right to informed consent, which entails that patients receive adequate information to make medical decisions. But many questions can arise if patients appear to lack the capacity to understand their medical condition or options. How is capacity determined? Who decides on behalf of the patient if the patient is determined to lack capacity? How should a surrogate decide on behalf of a patient?

In this Application Assignment you will analyze the legal and ethical issues around patient capacity and surrogate decision making by focusing on the following scenario:

An 83-year-old diabetic male, Mr. Jones, is brought in to the emergency department because of respiratory distress by his care-giving daughter, with whom he lives. In examining him, the emergency department physician discovers that Mr. Jones has gangrene on his right foot up to his ankle.

Mr. Jones’ daughter reports that her father has been diagnosed with Alzheimer’s disease. A preliminary capacity assessment is consistent with mild dementia, but one of the nurses suggests that Mr. Jones’ confusion might be the result of his respiratory distress, coupled with the disorienting atmosphere of the emergency department.

The clinical recommendation is to perform a below-the-knee amputation. The patient refuses this surgery, saying he has lived long enough and wants to die with his body intact. His daughter disagrees and says she wants everything done so that she can take him home as soon as possible, and says that she will sue the hospital if they do not perform the amputation. A social worker comments that the daughter might be afraid of an elder-neglect investigation if her father dies.

Mr. Jones does not have an advance directive of any kind and is not under guardianship. Assume that the applicable law in your state is the same as explained in the summary of the Uniform Health-Care Decisions Act

 


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