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+--- Thread: consent - sarat (/showthread.php?tid=66102)
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consent - sarat - ArchivalUser - 12-16-2005
1. A 55-year-old man has a 3-month history of chest pain and fainting spells. You feel his symptoms merit cardiac catheterization. You explain the risks and potential benefits to him, and include your assessment of his likely prognosis without the intervention. He is able to demonstrate that he understands all of this, but refuses the intervention.
Can he do that, legally? Should you leave it at that?
2. A 64-year-old woman with MS is hospitalized. The team feels she may need to be placed on a feeding tube soon to assure adequate nourishment. They ask the patient about this in the morning and she agrees. However, in the evening (before the tube has been placed), the patient becomes disoriented and seems confused about her decision to have the feeding tube placed. She tells the team she doesn't want it in. They revisit the question in the morning, when the patient is again lucid. Unable to recall her state of mind from the previous evening, the patient again agrees to the procedure.
Is this patient competent to decide? Which preference should be honored?
0 - ArchivalUser - 12-16-2005
1]I think he can do that...may be you dont want to leave him there... I WUD ask the reason-if it is fear,consider counselling by psycht/;if financial ref him to charitable hospital
cant think of any other reason.
2]may be the first one;to put it in.
0 - ArchivalUser - 12-16-2005
1.he has every right to decide about his medical care even if that means dying.u have to leave him alone
2.hmm this is tricky.If I am the doctor,I will consult the family about this.I dont consider the pt competent and in this case I would first look for any living will .If there isnt any,I will consult the family and do whatever they decide unanimously.How do u know the pt was competent while giving the first consent?
0 - ArchivalUser - 12-16-2005
in first q agree he has the right to refuse but in second q we should put tube without asking family because when she is lucid she wants tube and she is competent in nl situations,gl
0 - ArchivalUser - 12-16-2005
lucid=drunk
0 - ArchivalUser - 12-16-2005
i mean what is lucid?
0 - ArchivalUser - 12-16-2005
i guess it means that she is back to nl mental state
0 - ArchivalUser - 12-16-2005
but mahshid,my point is that this pt doesnot remember when she recovers what she said an what she wanted.Looking at her point of view,may be its wise to go for the lucid period,but when she recovers and says I asked u not to do that bcz she doesnot remember what she said at that time.This person has some obvious pathology going on and u cannot rely on her judgement.this can be a liability issue later when she can say I could not decide at that time and u believed me.If it was based on the first consent before the detrioration,I would have agreed..but bcz she counterdecided,so that also has no value in my opinion.This person is not competent to me.what do u say.
0 - ArchivalUser - 12-16-2005
but step1mom she gave us the consent when she was lucid and she said she doesnot want it when she was not ok and later when she was fine again she said that she doesnt remember to disagree and she want that so my perception is that when she is ok she wants it so i will put the tube ,plz any body else?gl
0 - ArchivalUser - 12-16-2005
competence is a legal issue not a medical issue.
only court can decide competence.
if u r unsure ,assume the pt. is competent.
clear behavioral evidence would be:
1. pt. attempts suicide.
2. pt. grossly psychotic n dysfuntional.
3.pt.'s physical n mental state prevents simple communication.