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Withhold lifesaving antibiotic treatment
72%
154/214
Administer ceftriaxone
6%
12/214
Administer TMP-SMX
4%
8/214
Call an ethics consult
14%
30/214
Obtain the signature of a second physician to have the patient declared as not having capacity
2%
5/214
Select Answer to see Preferred Response
The patient in this case has medical decision-making capacity, as demonstrated by her clear understanding of her illness and its possible treatment. Patients with decision-making capacity have a right to refuse treatment, even if that treatment may be lifesaving. The best course of action would be to respect the patient's wishes and withhold antibiotics. Decision-making capacity is reached when patients can make and discuss an informed choice that remains stable over time, is consistent with their other values, and is not made during delirium or psychosis. Advance directives may be used as a reference in decision-making if the patient is incapacitated. Tunzi uses case studies as a guide to help physicians assess decision-making capacity and notes that physicians should be suspicious if patients are either refusing recommended treatment suddenly or consenting more hastily than usual, or if they have undergone an abrupt change in mental status. Capacity assessments, in addition to mental status exam, should include whether patients understand info about treatment, whether they can apply it to their situation and make reasonable judgements and whether they can express their choice. As reviewed by Simpson, competent adults have the right to decline treatment even if this decision may lead to death. Healthcare professionals must make decisions on behalf of patients in some settings, such as when a trauma victim is brought unconscious into the ED. Illustration A is a chart showing how physicians may assess their patient's ability to carry out the tasks needed as a part of decision-making capacity. Incorrect answers: Answers 2 and 3: Patients with decision-making capacity have a right to refuse treatment. Administering antibiotics against the patient's wishes would be unethical. Answer 4: An ethics consult is not needed in this situation - the guiding ethical principles may be unambiguously applied in this case. Calling a consult is rarely the correct answer on the USMLE. Answer 5: The patient presented in the question stem demonstrates full decision-making capacity.
4.5
(4)
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