Delirium & Agitation
The assessment of medical decision-making capacity (DMC) has long been a core competency of the consultation-liaison psychiatrist. As such, there has been considerable clinical guidance and research on how to conduct medical DMC assessments and how those assessments relate to legal competence and the involvement of surrogate decision-makers. The premise of this workshop is that the standard approach to DMC evaluations is incomplete and often falls short for patients, families, and consulting teams asking for our help. Specifically, there has been limited practical guidance for treatment recommendations beyond the declaration of incapacity. Post DMC determination guidance is particularly needed when medical recommendations are in direct conflict with the explicit wishes of the incapacitated patient and therefore raises the prospect of treatment over patient’s objection. This case-based and interactive session will explore the conceptual, practical, ethical and legal aspects of treatment over the patient’s objection.
This session will review the standard approach DMC and offer a novel framework for approaching treatment decisions after incapacity in a case-based format. We will then explore the ethical and legal issues inherent in these situations before engaging in an interactive, group discussion employing Poll Everywhere technology and Think-Pair-Share techniques.
-- Dr. Rosenstein will introduce the session and provide a brief overview of the assessment of medical DMC (20 minutes).
-- Dr. Scheidler will use a case-based format to propose a novel framework for clinical recommendations after a patient is deemed to lack capacity (20 minutes).
-- Dr. Levenson will address the practical and ethical concerns raised by cases of treatment over objection (20 minutes).
-- Dr. Brendel will synthesize the major points of earlier talks and lead a discussion of this session utilizing Poll Everywhere technology and Think-Pair-Share techniques (30 minutes).