Decision-making capacity and alcohol abuse: clinical and ethical considerations in personal care choices.
Requests for competency assessment of elderly patients are among the more common referrals that medical and surgical units make to consultation-liaison psychiatrists. Special considerations arise when impairment in cognition, judgment and function arise in the context of substance abuse. At what point during the admission should the evaluation be made? What if the person does well on the cognitive exam but has shown repeated evidence of self-neglect and need for medical care? What role should the medical profession play in mandating that patients give up harmful addictions? In this paper, we describe a case that illustrates these problems, and discuss some of the clinical and ethical considerations involved in the assessment of personal care competence of patients with alcohol abuse, and provide guidelines for these assessments.
Hazelton
Lara D
LD
Department of Psychiatry, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada. lara.hazelton@cdha.nshealth.ca
Sterns
Gwenyth L
GL
Chisholm
Terry
T
D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000150:complications / Q000534:rehabilitation*; D002755:Choice Behavior; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D003657:Decision Making; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D016743:Mental Competency; D011570:Psychiatry; D012017:Referral and Consultation; D012648:Self Care