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Decision Making Capa

Decision Making Capacity-OM 4

Why is Decision Making Capacity important ? * it determines whether or not patients will have control over the decisions made for them......if no advanced directive or previous discussion about treatments
Physician respect and DMC ? * they respect it, unless the patient lacks decision making capacity
If Dr. proceeds with procedure when patient has DMC and refused ? * constitutes as assault and battery
If Dr. honors a patient that refused treatment, but lacks DMC ? * if Dr. honors it, the patient could be subjected to needless harm
Parts to a proper consent from a patient to receive a certain treatment ? Patient must posses: * capacity to understand and communicate * ability to reason * have a set of values and goals -others = consent is voluntary and understand consequences
When to assess DMC ? * before asking consent.....during H&E
Capacity vs. Competence ? * Capacity - clinically determined by physician * Competence - court/legal determinations by courts/judges
People who are deemed competent by the courts can have what issue? * they ARE court ruled competent, but may LACK capacity to make certain decisions * why DMC should be determined by physicians rather than courts
Ethical questions brought to light when DMC is questionable ? * respect autonomy * Dr. should act in patients best interests
If DMC is seriously impaired ? * DMC is taken from patient and given to a surrogate
Abilities a patient must possess to make health care decisions ? * understand condition *understand risks/consequences/benefits *value/weigh options of treatment v. non-treatment to their goals *to reason and deliberate options *to communicate decisions in a meaningful manner
Role of Mental Status Testing ? *tests orientation (person, place, time, and situation) * tests cognitive skills *** NONE test to see if they understand what their problem is or consequences of tmt vs. non-tmt
From nurses to the physicians can assess DMC, but who is held responsible for the final decision ? * the attending physician (no psychiatrist needed)
Some helpful things to do to help determine DMC ? * ask them to describe their issue, possible consequences, and what brought on the issue.
If patients advanced aged, demented, retarded, or depressed ? * may still possess DMC
DMC as it is related to different tasks ? (ex. bd drawn vs. advanced directives) * is task-related -patients may understand and have sufficient DMC for a simple task, but not for a more advanced task
DMC and permanence ? * may have DMC at one time, and not the next -if possible, delay decisions until reversible problems are corrected (ex. infection, electrolyte imbalance, medication effect)
Created by: thamrick800