When psychiatry and bioethics disagree about patient decision making capacity (DMC).
The terms "competency" and "decision making capacity" (DMC) are often used interchangeably in the medical setting. Although competency is a legal determination made by judges, "competency" assessments are frequently requested of psychiatrists who are called to consult on hospitalised patients who refuse medical treatment. In these situations, the bioethicist is called to consult frequently as well, sometimes as a second opinion or "tie breaker". The psychiatric determination of competence, while a clinical phenomenon, is based primarily in legalism and can be quite different from the bioethics approach. This discrepancy highlights the difficulties that arise when a patient is found to be "competent" by psychiatry but lacking in DMC by bioethics. Using a case, this dilemma is explored and guidance for reconciling the opinions of two distinct clinical specialties is offered.
Schneider
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University of California, Los Angeles School of Medicine, Veterans' Administration Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA. Paul.Schneider@med.va.gov
Bramstedt
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D000369:Aged, 80 and over; D026688:Bioethical Issues; D003134:Commitment of Persons with Psychiatric Disorders; D003657:Decision Making; D004185:Disability Evaluation; D006801:Humans; D008297:Male; D016743:Mental Competency / Q000523:psychology; D001523:Mental Disorders / Q000175:diagnosis; D026684:Personal Autonomy; D016312:Treatment Refusal / Q000523:psychology