Ethics for Lunch – “Assessment of Decision-Making Capacity”
1800 Orleans Street
Baltimore, MD 21287
Mr. C. is a 70 year old widower. His wife died two years ago and he has a daughter and three sons. His relationship with his children is marked by considerable conflict. He was recently hospitalized with gangrene in his right foot and lower leg. Problems with his foot began three years ago when he had an infection in a toe in his right foot which became gangrenous. It was then that he discovered that he was diabetic. The toe was amputated. Last year, he bruised his right leg while getting into a bus. The bruise developed into gangrene which resulted in an operation 6 months ago where a portion of his foot was amputated. At that time an arterial bypass was done to decrease the likelihood that gangrene would recur. He went from the hospital to a rehabilitation center, where he remained for five months. It was found that he had gangrene in the remainder of the foot. He was started on intravenous antibiotics with no response. A below knee operation was then suggested to him. On the morning of the operation he withdrew his consent and went home to stay with his daughter for three days. He has now been brought back to hospital by his daughter. Mr. C. has been unhappy since the death of his wife. He does not wish to burden his children, and he does not believe the operation will cure him. From Aid To Capacity Evaluation (ACE) – Training at Sunnybrook & Women’s College Health Sciences Centre Joint Centre for Bioethics, University of Toronto http://www.jcb.utoronto.ca/tools/documents/ace.pdf
1. Describe how to assess for decision making capacity.
2. Identify resources and tools to assist with assessment of decision making capacity.
3. Identify Psychiatry’s roles in assisting with capacity assessment.
4. Discuss surrogate decision making for patients who lack decision-making capacity.