title: A combined ethics & psychiatric consultation.
abstract: A case presentation is used to illustrate how psychiatrists can contribute to clinical ethics. A 75-year-old man with end-stage COPD was admitted to the ICU. His condition deteriorated and he lost decision-making capacity without expressing his wishes about end-of-life care. Although he no longer needed care in the ICU his surrogate decision-maker objected to his being transferred. Seven months after the patient's admission an ethics consultation was carried out by a psychiatrist-ethicist. The following issues are discussed, elaborating on points previously made by the authors [1,2]: the absence of an advance directive, surrogate decision-making, the allocation of ICU beds, guidelines for discharge from the hospital, the lateness of the ethics consultation, and the interweaving of ethical questions with psychiatric factors. The psychiatrist-ethicist was ideally suited to address all these issues and to make a significant contribution to the care of the patient and his family.
authors: Clinical Professor of Psychiatry and Faculty Associate, Division of Humanities in Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA. cp1@cpleeman.net
authors: C P
authors: CP
authors: Leeman
authors: J
authors: J
authors: Blum
authors: M S
authors: MS
authors: Lederberg
mesh_terms: D016223:Advance Directives; D000368:Aged; D003422:Critical Care / Q000191:economics; D017041:Ethics Committees; D005190:Family / Q000523:psychology*; D006801:Humans; D008297:Male; D011570:Psychiatry; D012121:Respiration, Artificial; D016414:Resuscitation Orders / Q000523:psychology*; D013727:Terminal Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000523:psychology; D020458:Third-Party Consent; D014481:United States