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* A 74-year-old woman
 #511124  
  acyclovir99 - 06/05/10 20:54
 
  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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* Re:A 74-year-old woman
#2123521
  acyclovir99 - 06/07/10 13:53
 
  The correct answer is A. This patient raises one of the most difficult legal
and ethical problems in psychiatry. It is important to understand that
competency, or lack of competency (choices B, C, and E), can be
determined only by a legal authority, such as a court of law. The role of
psychiatrists is solely advisory in determining competency. In this situation,
only if the patient is suicidal by virtue of a major psychiatric illness, or if the
patient were subject to an immediate medical emergency, could treatment
be involuntarily administered. The psychiatrist's role is to assess a person's
mental status for evidence of cognitive impairment, as well as to ascertain
that the patient has a thorough understanding of the consequences of
treatment decisions that are made. This patient does not meet criteria for
treatment against her will (choice D), which requires both a mental
disorder and the threat of impending immediate harm to self or others.

 
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* Re:A 74-year-old woman
#2123522
  neurosinapsis - 06/07/10 13:54
 
  I would choose A, competency is a legal term (i.e. a judge can declare competency) and physicians can not state that a patient is "competent" or not.  
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* Re:A 74-year-old woman
#2124191
  sdrzv11 - 06/08/10 12:46
 
  oh yeah now iremember....even if we know the concept we need to polish ourself by doing mcqs.... :-( :-)  
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* Re:A 74-year-old woman
#2124966
  sdrzv11 - 06/09/10 12:55
 
  oh yeah now iremember....even if we know the concept we need to polish ourself by doing mcqs.... :-( :-)  
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