Ethics Question from NBME 4

[medInUSA]

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Couldn't figure out an ethics question from NBME form 4

DOn't read further if you haven't done form 4 yet and dont want to see the question!!!!!!









A woman with schizophrenia is 12 weeks pregnant. She is admitted to the inpatient psych ward. She asks for an abortion because the baby is Evil!!
what do you do next?

Schedule the abortion and begin haldol?
DOn't schedule the abortion and begin haldol, and wait till the psychosis passes?

 

[tfom08]

I didn't do NBME 4, but definitely DO NOT schedule the abortion. In general, schizophrenic patients do have medical decision making capability. However, since this lady is clearly experiencing hallucinations/delusions, she needs to be treated for that prior to making medical decisions.

 

[medInUSA]

I was thinking that but I was also thinking, the doctors cannot declare competence only the courts can do that right? So just because she is saying the child is evil, how can we say she is incompetent to make her own decisions? Or is the fact that the doctors say that she has psychosis enough to overpower her wishes?

 

[tfom08]

I was thinking that but I was also thinking, the doctors cannot declare competence only the courts can do that right? So just because she is saying the child is evil, how can we say she is incompetent to make her own decisions? Or is the fact that the doctors say that she has psychosis enough to overpower her wishes?

You are overthinking this IMO. If a schizophrenic patient is actively hallucinating or experiencing delusional thinking, you don't perform an abortion because "the baby is evil." And even if the court is needed to confirm incompetence, you don't perform the abortion and then check with the court. You would treat conservatively and wait for the court to make a final decision. But it doesn't matter, you just don't do the abortion.