achilles
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17) A 74-year-old woman with a long history of type 2 diabetes mellitus undergoes surgery for small bowel obstruction. After surgery, she develops acute renal failure. However, she refuses to undergo dialysis on the advice of her physician, who then calls for an immediate psychiatric consultation. The patient tells the psychiatrist that she has lived a long life and does not want to be kept alive by or attached to a machine, even if it means she will die. A mental status examination shows that she is not psychotic, that she is fully oriented and alert, and that she has no fluctuations of cognition or level of consciousness. The patient's family is insistent that she be dialyzed immediately. Which of the following is the most appropriate statement the psychiatric consultant could make?
A. The patient is aware of the consequences of her decision and does not show signs of a major psychiatric illness.
B. The patient is competent to decide on treatment, and her refusal to undergo dialysis must be respected.
C. The patient is competent to decide on treatment, but her refusal can be overruled because of a medical emergency.
D. The patient is operating in a suicidal manner and should be committed for treatment against her will.
E. The patient is temporarily incompetent, so start her on dialysis.
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| p53
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B.
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| an
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A.
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| kmp
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B. The patient is competent to decide on treatment, and her refusal to undergo dialysis must be respected.
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| DrS
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B. The patient is competent to decide on treatment, and her refusal to undergo dialysis must be respected.
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| achilles
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the answer is A
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| achilles
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competency or lack of competency can only be determined by a legal authority such as a court of law. the role of the psychiatrist is solely advisory in determining the competency.this rules out options B , C and E. and the patient is definitely not suicidal as the mental status exam was completely normal.so D is not the answer either. the answer is A.
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| DrS
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good one!
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| achilles
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| p53
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"Although physicians (especially psychiatrists) often give opinions on competence, only a judge's ruling converts the opinion into a finding; a patient is not competent or incompetent until the court so rules. The diagnosis of a mental disorder is not, in itself, sufficient to warrant a finding of incompetence. Instead, the mental disorder must cause an impairment in judgment for the specific issues involved."
- from 'Kaplan & Sadock's Concise Textbook of Clinical Psychiatry'.
great question! cograts, an, for correct answer!
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| achilles
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thanks for checking the text on the answer and the input p53...really appreciate it.good luck.
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| frontal
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Great question. May I just extend it a bit and ask your views on what the physician's course of action should be?
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| achilles
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well i guess the patient is an adult and the mental exam is normal and she has the right to refuse treatment even if it is life saving for her. she cannot refuse treatment if it had been an infectious dz which could be transmitted to others or any condition which could be harmful to others around her. only in that case can she not refuse treatment.
so the physician has to respect her decision of not wanting a life saving dialysis.
i hope i did answer in the same context of what you asked. these questions can be tricky.
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