Decision making capacity - amputation ??

[Kobebucsfan]

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hypothetical question

Lets say a surgeon wants to amputate the right foot. The pt is alert to person,place but NOT TIME. pt thinks she is in year 1990. Pt understand the procedure and consents to surgery. Pt sister not available currently.


a. Counsel with Hospital Attorney

b. Wait until you get in touch with pt’s sister

c. Get Psychic counsel to determine her decision-making capacity

d. Give her antibiotics and reschedule surgery 1mo later

e. Proceed with amputation


What if her MMSE was 23/30 or 26/30. would it change the answer ?

 

[sahell]

e. Proceed if the patient has understood the benefits and risks, has made a choice, and has a rationale for the choice. I think there's a UW question like this.

 

[Prince090]

hypothetical question

Lets say a surgeon wants to amputate the right foot. The pt is alert to person,place but NOT TIME. pt thinks she is in year 1990. Pt understand the procedure and consents to surgery. Pt sister not available currently.


a. Counsel with Hospital Attorney

b. Wait until you get in touch with pt’s sister

c. Get Psychic counsel to determine her decision-making capacity

d. Give her antibiotics and reschedule surgery 1mo later

e. Proceed with amputation


What if her MMSE was 23/30 or 26/30. would it change the answer ?

Deferring an action to a lawyer or any committee when it comes to Step 1 is never a right answer, so that rules out option A and C. Since the patient understands the procedure and consents to it, that means he is legally a sound person or to be more precise " competent." Being competent is a legal definition , not a medical one. Since the patient is competent , that rules out option B and D.

 

[Kobebucsfan]

her not being oriented to time doesnt matter ? i thought u have to oriented to person time place to be actively capable of decision making

 

[sahell]

Not according to UW. Demented patients can give informed consent.