A noncompliant patient with fluctuating capacity.
Because of intermittent refusal of both dialysis and medications, serial capacity assessments were made on a 38-year-old male on hemodialysis and receiving TB treatment. His capacity to make an informed treatment decision appeared to fluctuate and despite multidisciplinary involvement and a court determination that treatment should take place, questions remained as to how such a case should be managed in the patient's best interest. The process of making a capacity determination was reviewed from both a psychiatric and legal viewpoint and alternative strategies presented.
O'Dowd
M A
MA
Department of Epidemiology and Social Medicine, Montefiore Medical Center, NY 10467, USA.
Jaramillo
J
J
Dubler
N
N
Gomez
M F
MF
D000328:Adult; D000987:Antisocial Personality Disorder / Q000175:diagnosis / Q000523:psychology; D003693:Delirium / Q000175:diagnosis / Q000523:psychology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000523:psychology; D005104:Expert Testimony / Q000331:legislation & jurisprudence*; D006801:Humans; D016030:Kidney Transplantation / Q000523:psychology; D008016:Life Change Events; D008297:Male; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D010348:Patient Care Team / Q000331:legislation & jurisprudence; D011569:Psychiatric Status Rating Scales; D006435:Renal Dialysis / Q000523:psychology; D012803:Sick Role; D016312:Treatment Refusal / Q000331:legislation & jurisprudence*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000523:psychology