The Use of an Advance Directive in Consultation-Liaison Psychiatry: A Case Report

1994 ◽  
Vol 24 (4) ◽  
pp. 371-376 ◽  
Author(s):  
Steven A. Epstein ◽  
Eduina Martins ◽  
Margaret A. Crowley ◽  
Marie F. Pennanen
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Case Report ◽  
Advance Directive ◽  
Preoperative Anxiety ◽  
Liaison Psychiatry ◽  
Decision Making Capacity ◽  
Consultation Liaison Psychiatry ◽  
Psychiatric Advance Directive ◽  
Surgical Setting

Objective: The following case report illustrates the use of a psychiatric advance directive in a surgical setting. Method: The case of a woman with breast cancer and debilitating pre-operative anxiety is presented. Her anxiety was so severe that it resulted in repeated refusal to have necessary surgery. An advance directive facilitated proceeding with surgery despite her objections in the immediate pre-operative period. Conclusion: Consultation-Liaison psychiatrists should consider the use of an advance directive when preoperative anxiety interferes with decision-making capacity.

Psychopharmacological treatments strategies in consultation-liaison psychiatry: Clinical vignette and pros and cons

2016 ◽  
Vol 33 (S1) ◽  
pp. S61-S61
Author(s):  
G. Mattei ◽  
N. Colombini ◽  
S. Ferrari ◽  
G.M. Galeazzi
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Vignette ◽  
Pharmacological Intervention ◽  
Computer Assisted ◽  
Liaison Psychiatry ◽  
Pros And Cons ◽  
Consultation Liaison Psychiatry ◽  
Ward Personnel ◽  
Computer Assisted Decision Making

IntroductionMultimorbidity and polipharmacotherapy are crucial features influencing the psychiatrist's prescription in the consultation-liaison psychiatry (CLP) setting.Aimsto provide an example of computer-assisted decision-making in psychotropic prescriptions and to provide hints for developing pharmacological treatment strategies in the CLP setting.MethodsCase report. A clinical vignette is presented, followed by a review of available online computer-assisted prescription software.ResultsA woman in her seventies was repeatedly referred for psychiatric consultation. Eleven different medications were administered daily, because of multimorbidity. A diagnosis of distymia was established, with comorbid mixed pain (partly fulfilling the criteria of somatic symptom disorder) and substance use disorder (opioids). After the first assessment, six follow-up visits were needed during hospitalization. Mirtazapine and benzodiazepines were introduced. Beside the pharmacological intervention, conflict mediation was performed in the relationship with the patient, her relatives, the ward personnel and the GP, to develop a long-term rehabilitation project. Pros and cons of online computer-assisted prescription software were discussed together with the ward personnel, as well.ConclusionsComputer-assisted decision-making in psychotropic prescription is becoming more common and feasible. The use of available software may contribute to safety, effectiveness and cost-effectiveness of clinical decision-making. Risks are also possible: depending for example from regional differences in prescription indications, different guidelines, pharmacogenomics, frequency with which databases are updated, sponsorships, possible conflicts of interest, and real clinical significance of highlighted interactions – all issues the clinician willing to benefit from this modern tools should pay attention to.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

2018 ◽  
Author(s):  
Laura Stafman ◽  
Sushanth Reddy
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Directives ◽  
Advance Directive ◽  
Persistent Vegetative State ◽  
Living Will ◽  
Do Not Resuscitate ◽  
Power Of Attorney ◽  
Decision Making Capacity ◽  
Do Not Resuscitate Orders

In 2005, Terri Schiavo collapsed at home and was found by her husband without respirations or a pulse. She was resuscitated, but suffered severe anoxic brain injury and after 21/2 months was diagnosed as being in a persistent vegetative state. A court appointed her husband as her legal guardian as she did not have a written advance directive and had not specified a power of attorney for health care (POAHC), but heated court battles raged between her husband and her parents regarding who should be making decisions and what the appropriate decisions were. This case highlights the importance of writing down instructions for end-of-life care or designating someone to make decisions in their best interest in the event they could not make these decisions themselves. This review covers advance directives, do-not-resuscitate orders, and POAHC. Figures show an extended values history form, an example of a living will, the California’s Physician Orders for Life-Sustaining Treatment form, components of the CURVES mnemonic to assess decision-making capacity in critical/emergency situations, and activation and deactivation of power of attorney for health care. Tables list the most common types of advance directive and description of each, barriers to the use of advance directives, common themes in surgeons’ attitudes regarding advance directives, general requirements and exclusions for POAHC, and requirements for decision-making capacity in patients. This review contains 5 highly rendered figures, 5 tables, and 56 references

scholarly journals Decision Making Capacity or How to Accept Patient’s Refusal for Orthodontic Treatment

2021 ◽  
Vol 2 (4) ◽  
pp. 1-5
Author(s):  
Yulia Bogdanova Peeva
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Orthodontic Treatment ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Treatment Protocol ◽  
Class Iii ◽  
Decision Making Capacity ◽  
Sharing Responsibility ◽  
The Individual

Introduction: Communication in dentistry is bilateral process which usually is based on response (understanding) by the person. That’s why the Oral Healthcare Providers (OHP) should be convinced the consent given by the patient is valid. It means that at the beginning of the treatment the orthodontist will ask a lot of questions and have expectations to receive appropriate answers. There is a specific lack of awareness about the first orthodontic consultation at 7y of age, occurrence and prevention of most of the common tooth jaw discrepancies which affect the oral health, self-confidence and overall development of the child. A variety of socio-demographic, educational, personal and other factors mostly divided into objective and subjective factors influences the perception of facial attractiveness. The orthodontic treatment lays down on the personal desire and attitudes, depends from the motivation but is not without a risk for the patient. The aim of the current research is to present the most objective and subjective factors identifying the patient’s refusal. Material and methods: It’s a case report based on preliminary discussion and orthodontic consultation over the cephalometric analysis and cast models. Orthodontic treatment protocol was followed and given informed consent by the individual was received. Results and discussions: An electronic search was conducted using the Medline database (PubMed), Science Direct, and Scopus. In this case report were described the treatment options for Class III malocclusion with an emphasis on maxillary protraction and existing impacted canine 13. The decision making capacity was evaluated and also what are the objective and subjective factors and how to proceed with patient refusal. Conclusions: Despite the orthodontist’s efforts to improve the management of the dental practice and to attract new patients, these challenges should never been from the first importance. Contemporary dentistry requires that the patient’s right to refuse should be respected and this refusal must be accepted. Because orthodontic treatment is expensive, the process of returning money or sharing responsibility for the treatment depend on the socio-cultural characteristics of both the patient and the doctor. The whole situation requires a very delicate approach, as it affects the image of the dental community in society at whole.

Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

2016 ◽  
Author(s):  
Laura Stafman ◽  
Sushanth Reddy
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Directives ◽  
Advance Directive ◽  
Persistent Vegetative State ◽  
Living Will ◽  
Do Not Resuscitate ◽  
Power Of Attorney ◽  
Decision Making Capacity ◽  
Do Not Resuscitate Orders

In 2005, Terri Schiavo collapsed at home and was found by her husband without respirations or a pulse. She was resuscitated, but suffered severe anoxic brain injury and after 21/2 months was diagnosed as being in a persistent vegetative state. A court appointed her husband as her legal guardian as she did not have a written advance directive and had not specified a power of attorney for health care (POAHC), but heated court battles raged between her husband and her parents regarding who should be making decisions and what the appropriate decisions were. This case highlights the importance of writing down instructions for end-of-life care or designating someone to make decisions in their best interest in the event they could not make these decisions themselves. This review covers advance directives, do-not-resuscitate orders, and POAHC. Figures show an extended values history form, an example of a living will, the California’s Physician Orders for Life-Sustaining Treatment form, components of the CURVES mnemonic to assess decision-making capacity in critical/emergency situations, and activation and deactivation of power of attorney for health care. Tables list the most common types of advance directive and description of each, barriers to the use of advance directives, common themes in surgeons’ attitudes regarding advance directives, general requirements and exclusions for POAHC, and requirements for decision-making capacity in patients. This review contains 5 highly rendered figures, 5 tables, and 56 references

scholarly journals Recurrence of endometrial cancer in a hysterectomised patient treated with tamoxifen for breast cancer: a case report

2020 ◽  
Vol 113 (11) ◽  
pp. 454-456 ◽  
Author(s):  
James Woolas ◽  
Megan Davis ◽  
Siavash Rahimi
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Endometrial Cancer ◽  
Case Report ◽  
Medical History ◽  
Shared Decision Making ◽  
Decision Making Process ◽  
Shared Decision ◽  
Past Medical History ◽  
The Past

Tamoxifen exposure is a recognised risk for primary endometrial cancer. This case serves as a reminder to meticulously check the past medical history and inform patients of the risk-benefit of treatment as part of a shared-decision making process.

Advance Directives, Do Not Resuscitate Orders, and Power of Attorney for Health Care

2016 ◽  
Author(s):  
Laura Stafman ◽  
Sushanth Reddy
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Advance Directives ◽  
Advance Directive ◽  
Persistent Vegetative State ◽  
Living Will ◽  
Do Not Resuscitate ◽  
Power Of Attorney ◽  
Decision Making Capacity ◽  
Do Not Resuscitate Orders

In 2005, Terri Schiavo collapsed at home and was found by her husband without respirations or a pulse. She was resuscitated, but suffered severe anoxic brain injury and after 21/2 months was diagnosed as being in a persistent vegetative state. A court appointed her husband as her legal guardian as she did not have a written advance directive and had not specified a power of attorney for health care (POAHC), but heated court battles raged between her husband and her parents regarding who should be making decisions and what the appropriate decisions were. This case highlights the importance of writing down instructions for end-of-life care or designating someone to make decisions in their best interest in the event they could not make these decisions themselves. This review covers advance directives, do-not-resuscitate orders, and POAHC. Figures show an extended values history form, an example of a living will, the California’s Physician Orders for Life-Sustaining Treatment form, components of the CURVES mnemonic to assess decision-making capacity in critical/emergency situations, and activation and deactivation of power of attorney for health care. Tables list the most common types of advance directive and description of each, barriers to the use of advance directives, common themes in surgeons’ attitudes regarding advance directives, general requirements and exclusions for POAHC, and requirements for decision-making capacity in patients. This review contains 5 highly rendered figures, 5 tables, and 56 references

Medical-Surgical Psychiatry and Medical Ethics

2014 ◽  
Author(s):  
James J. Strain ◽  
Rosamond Rhodes
Keyword(s):  
Decision Making ◽  
Ethical Dilemmas ◽  
Ethical Reasoning ◽  
Surrogate Decision Making ◽  
Truth Telling ◽  
Liaison Psychiatry ◽  
Dual Agency ◽  
Consultation Liaison Psychiatry ◽  
Surrogate Decision ◽  
Latent Content

Consultation-liaison Psychiatry is the newest sub-specialty in psychiatry. It focuses on the psychological/psychiatric care of medical, surgical, obstetrical, and gynecological patients and presents many distinctive ethical dilemmas. These dilemmas often involve judgments of capacity and justified paternalism, manifest versus latent content, surrogate decision making, confidentiality, truth telling, dual agency, refusing treatment, decisions to end life, surrogate decision-making, and the complexity of interdisciplinary moral relationships. This interface between psychiatry, medicine, and ethics highlights the need for bioethical teaching within medical school, residency, and fellowship education. Ethical reasoning needs to be in the repertoire of the contemporary physician especially now, given the rapidly expanding choices that must be made in today’s medicine. This chapter provides examples of ethical dilemmas that arise in Consultation/Liaison Psychiatry and illustrations of the ethical analysis that can be used to resolve them.

scholarly journals Capacity in vacuo: An audit of decision-making capacity assessments in a liaison psychiatry service

2017 ◽  
Vol 41 (1) ◽  
pp. 7-11 ◽  
Author(s):  
Benjamin W. J. Spencer ◽  
Gareth Wilson ◽  
Ewa Okon-Rocha ◽  
Gareth S. Owen ◽  
Charlotte Wilson Jones
Keyword(s):  
Decision Making ◽  
Educational Intervention ◽  
Mental Capacity ◽  
Clinical Implications ◽  
Liaison Psychiatry ◽  
Factors Associated ◽  
Decision Making Capacity ◽  
Mental Capacity Act 2005 ◽  
Legal Model ◽  
Mental Capacity Act

Aims and methodWe aimed to audit the documentation of decision-making capacity (DMC) assessments by our liaison psychiatry service against the legal criteria set out in the Mental Capacity Act 2005. We audited 3 months split over a 2-year period occurring before, during and after an educational intervention to staff.ResultsThere were 21 assessments of DMC in month 1 (6.9% of all referrals), 27 (9.7%) in month 16, and 24 (6.6%) in month 21. Only during the intervention (month 16) did any meet our gold-standard (n = 2). Severity of consequences of the decision (odds ratio (OR) 24.4) and not agreeing to the intervention (OR = 21.8) were highly likely to result in lacking DMC.Clinical implicationsOur audit demonstrated that DMC assessments were infrequent and poorly documented, with no effect of our legally focused educational intervention demonstrated. Our findings of factors associated with the outcome of the assessment of DMC confirm the anecdotal beliefs in this area. Clinicians and service leads need to carefully consider how to make the legal model of DMC more meaningful to clinicians when striving to improve documentation of DMC assessments.

A suicidal, dysarthric patient who wishes to discontinue life-sustaining treatments: A case report

2018 ◽  
Vol 53 (4) ◽  
pp. 306-309
Author(s):  
Zachary Orlins
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Ethical Principles ◽  
Suicidal Patient ◽  
Best Interest ◽  
Decision Making Capacity ◽  
Life Sustaining Treatment

Psychiatrists may be among the clinicians to encounter a depressed and suicidal patient who wishes to discontinue life-sustaining treatment. A patient who is suffering from a condition such as dysarthria makes decision-making capacity (a physician’s determination of a patient’s ability to medically consent) increasingly difficult to assess. The clinician must balance ethical principles of autonomy, non-maleficence, beneficence, and justice in order to achieve a plan of care that is in the patient’s best interest.

Sign in / Sign up

Export Citation Format

Share Document