Decision Making Capacity-OM 4
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| 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
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| Physician respect and DMC ? | * they respect it, unless the patient lacks decision making capacity
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| If Dr. proceeds with procedure when patient has DMC and refused ? | * constitutes as assault and battery
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| If Dr. honors a patient that refused treatment, but lacks DMC ? | * if Dr. honors it, the patient could be subjected to needless harm
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| 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
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| When to assess DMC ? | * before asking consent.....during H&E
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| Capacity vs. Competence ? | * Capacity - clinically determined by physician
* Competence - court/legal determinations by courts/judges
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| 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
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| Ethical questions brought to light when DMC is questionable ? | * respect autonomy
* Dr. should act in patients best interests
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| If DMC is seriously impaired ? | * DMC is taken from patient and given to a surrogate
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| 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
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| 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
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| From nurses to the physicians can assess DMC, but who is held responsible for the final decision ? | * the attending physician (no psychiatrist needed)
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| Some helpful things to do to help determine DMC ? | * ask them to describe their issue, possible consequences, and what brought on the issue.
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| If patients advanced aged, demented, retarded, or depressed ? | * may still possess DMC
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| 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
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| 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)
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thamrick800
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