Ethics Q

[LeLu]

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How do you determine if a patient is incompetent & what to do next if they are incompetent (how to force treatment)?

It says in FA - almost never refer to another person...

I had a Q that was like - adult with schizo (lives in psych ward) refuses treatment for a serious burn wound (in ER) because they are paranoid, says they will accept treatment later that day when someone they trust arrives.

1) Do you proceed with treatment because their paranoia = incompetent?
2) Proceed because their schizo diagnosis = incompetent?
3) Proceed because they live in a psych ward?
4) Not do treatment until you get court order?
5) Not do treatment until psych eval?
6) Not do treatment & check if trusted person is coming.

😕

 

[jmcappleby]

How do you determine if a patient is incompetent & what to do next if they are incompetent (how to force treatment)?

It says in FA - almost never refer to another person...

I had a Q that was like - adult with schizo (lives in psych ward) refuses treatment for a serious burn wound (in ER) because they are paranoid, says they will accept treatment later that day when someone they trust arrives.

1) Do you proceed with treatment because their paranoia = incompetent?
2) Proceed because their schizo diagnosis = incompetent?
3) Proceed because they live in a psych ward?
4) Not do treatment until you get court order?
5) Not do treatment until psych eval?
6) Not do treatment & check if trusted person is coming.

😕

I think because of the urgency of the case, you would go ahead and treat because the patient is incompetent.

 

[FutureDoc4]

Basically, I'd have to see the options but it goes like this:

First, we don't determine competence (courts dO):

If we "think" incompetent:

A) Emergency--Tx then get permission after

B) Non-emergency-don't Tx get court order

Even if Schizophenic, the patient may be competent, if so (and you should assume competence in a test question):

They have the right to refuse/accept diff tx even if institutionalized involuntarily.

 

[IMGUSMLEStep1]

This is a tough one. In this case, the patient's paranoia is interfering with his ability to make a medical decision. Since this is a serious burn, the ideal answer would be to treat the patient. (1)

Answers 2 and 3 do not mean that the patient is incompetent and are not reasons to treat without consent

 

[jmcappleby]

I think because of the urgency of the case, you would go ahead and treat because the patient is incompetent.

Yeah, to clarify, I wasn't meaning that Schizophrenia = incompetent, but rather what the above poster said more clearly - i.e. that his current situation was interfering with his decision-making in what apparently seems like an emergency case. Because of this, you should probably go ahead and treat.

Similar to questions of ectopic pregnancy when doing surgery for something else - you didn't get permission from the patient for that particular surgery, and the patient is completely competent, but it's best for you to just do the necessary surgery right there rather than waking up the patient and asking for informed consent.