Determining the decision-making capacity of a patient who refused food and water

• Published in: Palliative medicine Vol. 15; no. 1; pp. 55 - 60
• Main Author: Terman, Stanley A
• Format: Journal Article
• Language: English
• Published: Thousand Oaks, CA SAGE Publications 01.01.2001; Turpin; Sage Publications Ltd
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Assessment; Bioethics; Biological and medical sciences; Clinical death. Palliative care. Organ gift and preservation; Competence; Decision Making; Ethical aspects; Euthanasia, Passive - psychology; Female; Humans; Life sustaining treatment; Medical sciences; Mental Competency; Palliative Care; Psychiatric Status Rating Scales; Psychometrics; Refusal; Terminally Ill - psychology; Terminally ill people; Treatment Refusal - psychology; United States > US; mental competency; terminally ill; dehydration; biothics; euthanasia (passive); palliative care; Human; Evaluation; Decision making; Patient; Terminal stage; Denial; Feeding; Case study; Capacity; Palliative care; Female; Resuscitation; Public health; Death and Euthanasia
• ISSN: 0269-2163; 1477-030X
• DOI: 10.1191/026921601672818272

A terminal patient expressed the wish to hasten her death and refused nutrition. The psychiatrist asked to render an opinion relevant to her competence employed questions in a semi-structured interview derived from a new instrument originally designed to determine competence to create ‘Advance Directives’. Although the patient ultimately demonstrated her resolve by totally ceasing fluid intake, the complexity of the case–including the question of the stability of her choice–illustrates the need for specific patient safeguards.