Match each patient scenario involving a refusal of medical intervention with the most appropriate assessment of decision-making capacity and subsequent clinical action.
- A 17-year-old active-duty military service member with a closed tibial fracture who refuses operative fixation because he fears surgical hardware will end his career, fully understanding the risks of nonunion and chronic pain.Retains capacity as an emancipated minor; honor the refusal of operative fixation.
- A 34-year-old man brought to the emergency department after a bar fight with a deep bleeding scalp laceration, who has severely slurred speech, unsteady gait, and aggressively demands to leave without treatment.Lacks capacity due to acute situational impairment; prevent from leaving and treat the emergency condition.
- An 82-year-old woman with early-stage Alzheimer dementia admitted for severe dysphagia, who refuses a feeding tube, clearly stating she understands she will die of malnutrition but prefers comfort-focused care.Retains capacity despite cognitive deficits as she demonstrates intact reasoning for this specific decision; honor the refusal of the procedure.
- A 28-year-old man with schizophrenia admitted for acute bacterial meningitis, who refuses intravenous antibiotics because he believes the fluids contain government-designed microchips to track his thoughts.Lacks capacity as psychiatric symptoms directly impair the appreciation of the medical intervention; seek a surrogate decision-maker.
Answer
The 17-year-old soldier retains capacity as an emancipated minor. The intoxicated man lacks capacity due to acute impairment. The woman with dementia retains capacity despite her cognitive deficits. The man with schizophrenia lacks capacity because his psychiatric symptoms directly impair his appreciation of the treatment.
Decision-making capacity requires a patient to communicate a choice, understand the medical situation, appreciate the consequences, and reason rationally. Emancipated minors have the legal right to decide. Intoxication temporarily removes capacity. Baseline dementia does not automatically remove capacity if the patient can reason about the specific decision. Psychotic delusions that directly incorporate the treatment eliminate the ability to appreciate the medical reality.
Step-by-Step Solution
Key Concept
Decision-making capacity is decision-specific and depends on the patient's ability to communicate a choice, understand the relevant information, appreciate the situation and its consequences, and reason about treatment options.
Estimated Time:2m 0s