The woman who wanted electroconvulsive therapy and do-not-resuscitate status. Questions of competence on a medical-psychiatry unit.
A case involving an elderly woman suffering concurrently from serious psychiatric and medical illnesses is presented. Ethical considerations concerning her treatment on a medical-psychiatry unit are discussed with special attention to her requests for both electroconvulsive therapy (ECT) and do-not-resuscitate (DNR) status. The compatibility of simultaneous requests for ECT and DNR is examined on three levels. The effect of depression upon competence to request and refuse treatment is analyzed. This case illustrates a conflict between medical and psychiatric treatment goals and ethical traditions which will become more common as psychiatrists treat older and more medically ill patients.
Sullivan
M D
MD
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195.
Ward
N G
NG
Laxton
A
A
D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D032882:Comprehension; D003866:Depressive Disorder / Q000523:psychology*; D004565:Electroconvulsive Therapy / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000331:legislation & jurisprudence*; D008173:Lung Diseases, Obstructive / Q000523:psychology; D028642:Persons with Psychiatric Disorders; D026684:Personal Autonomy; D016414:Resuscitation Orders / Q000331:legislation & jurisprudence*; D012803:Sick Role; D013405:Suicide / Q000523:psychology