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When psychiatry and bioethics disagree about patient decision making capacity (DMC)
  1. P L Schneider1,
  2. K A Bramstedt2
  1. 1University of California, Los Angeles School of Medicine, Bioethics Committee, Veterans’ Administration Greater Los Angeles Healthcare System, Los Angeles, California, USA
  2. 2Department of Bioethics, Cleveland Clinic Foundation, Cleveland, Ohio, USA
  1. Correspondence to:
 Paul L Schneider
 MD, FACP, Associate Clinical Professor of Medicine, University of California, Los Angeles School of Medicine, Chair, Bioethics Committee, Veterans’ Administration Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA; Paul.Schneider{at}med.va.gov

Abstract

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.

  • DMC, decision making capacity
  • VA, Veterans’ Administration
  • decision making capacity
  • competency
  • ethics
  • psychiatry
  • refusal of treatment

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