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Old 08-27-2012
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Default psychiatry question

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.

answer with reason
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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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Answer B) because patient is competent ,oriented to time place and person ,not depressed/suicidal ,not having delusion/hallucinations.She is competent to take a decision and refuse to treatment.

A) Though she is aware of her consequences ,not all major psychiatric illnesses are contraindications to making a decision for oneself.

C)This happens if she was a minori.e <18

D)She is aware of her consequences and she is not depressed/suicidal (SIGGECAPS)

E)She is competent
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I also answered B but this is what they say=


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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Quote:
Originally Posted by K06100 View Post
A 74-year-old woman 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
answer with reason
but how psychiatric could say that she does not show signs of major psychiatric illness? its because of her age or in other way?? she may be fine( indirectly this sentence tells that pt.is incompetent acording to psychiatrist)??
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