02-13-2010, 09:28 PM
Charlotte, a 54-year-old married female, has insulindependent diabetes and has been with you for her care for the last 7 years. In the last year she has begun to manifest some of the complications of chronic hyperglycemia, with retinopathy and neuropathy. Yet to your great frustration, Charlotte continues to resist the recommended lifestyle changes required to effectively manage her diabetes.
She is a casual, friendly woman known as the œcandy lady in her neighborhood, where she lives with her husband of 30 years. She loves children and volunteers at the local elementary school, where she is well known for a quick smile, a reassuring hug, and a piece of candy in her large pockets. In fact, she is noted during most of her appointments to be munching on M&M™s”her favorite candy. She has had dietary consults and many education-oriented doctor appointments but says, œI know I shouldn™t eat the way I do, but I just don™t have the heart to change who I am, even if it does help my eyes and legs. Who I am is about what I eat and do.
You wonder about Charlene™s capacity for decision making, given her frank noncompliance with care, even in the setting of severe complications from her diabetes.
Based on the necessary requirements for decision-making capacity, what is the MOST relevant piece of information in Charlotte™s provided account that suggests that her capacity is intact?
A) Therapeutic alliance with you despite noncompliance with treatment recommendations.
B) Integration into community relationships, including a stable marriage and responsibilities in the elementary school.
C) Expression of placing perceived self-identity as a higher priority than controlled diabetes and its complications.
D) Awareness that her dietary choices are associated with symptoms of eye disease and neuropathy.
E) Flagrant disregard for medical recommendations by eating candy while at her appointment.
She is a casual, friendly woman known as the œcandy lady in her neighborhood, where she lives with her husband of 30 years. She loves children and volunteers at the local elementary school, where she is well known for a quick smile, a reassuring hug, and a piece of candy in her large pockets. In fact, she is noted during most of her appointments to be munching on M&M™s”her favorite candy. She has had dietary consults and many education-oriented doctor appointments but says, œI know I shouldn™t eat the way I do, but I just don™t have the heart to change who I am, even if it does help my eyes and legs. Who I am is about what I eat and do.
You wonder about Charlene™s capacity for decision making, given her frank noncompliance with care, even in the setting of severe complications from her diabetes.
Based on the necessary requirements for decision-making capacity, what is the MOST relevant piece of information in Charlotte™s provided account that suggests that her capacity is intact?
A) Therapeutic alliance with you despite noncompliance with treatment recommendations.
B) Integration into community relationships, including a stable marriage and responsibilities in the elementary school.
C) Expression of placing perceived self-identity as a higher priority than controlled diabetes and its complications.
D) Awareness that her dietary choices are associated with symptoms of eye disease and neuropathy.
E) Flagrant disregard for medical recommendations by eating candy while at her appointment.
