title: The use of an advance directive in consultation-liaison psychiatry: a case report.
abstract: OBJECTIVE
  The following case report illustrates the use of a psychiatric advance directive in a surgical setting.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Consultation-Liaison psychiatrists should consider the use of an advance directive when preoperative anxiety interferes with decision-making capacity.
authors.affiliation: Department of Psychiatry, Georgetown University Medical Center, Washington, D.C. 20007, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Epstein
authors.forename: E
authors.initials: E
authors.lastname: Martins
authors.forename: M A
authors.initials: MA
authors.lastname: Crowley
authors.forename: M F
authors.initials: MF
authors.lastname: Pennanen
mesh_terms: D016223:Advance Directives; D001008:Anxiety Disorders / Q000209:etiology*; D001943:Breast Neoplasms / Q000523:psychology* / Q000601:surgery; D005260:Female; D006801:Humans; D007258:Informed Consent; D008875:Middle Aged; D011570:Psychiatry; D012017:Referral and Consultation