title: Ethics in practice.
abstract: H. K. is a ninety-two-year-old woman with Alzheimer's disease and mild hypertension. She resides at a nursing home, where she transfers from bed to chair with maximal assistance. She presents to our emergency department with a painful right hip. Physical examination demonstrates a confused, elderly patient with significant right hip pain and shortening and external rotation of the lower extremity. Radiographs demonstrate a displaced intertrochanteric hip fracture. The patient lacks the capacity for informed consent. Her family is contacted to obtain consent for insertion of a compression screw. The family refuses to give consent, stating that the patient is too old and the surgery is too dangerous.
authors.affiliation: Department of Orthopaedics, Mount Sinai Medical Center, New York, NY 10128, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Capozzi
authors.forename: R
authors.initials: R
authors.lastname: Rhodes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000150:complications*; D003657:Decision Making; D004992:Ethics, Medical; D005260:Female; D006620:Hip Fractures / Q000150:complications / Q000601:surgery*; D006801:Humans; D020458:Third-Party Consent