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Previous Volume 357:1834-1840 November 1, 2007 Number 18 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations.

A 75-year-old woman with type 2 diabetes mellitus and peripheral vascular disease is admitted with a gangrenous ulcer of the plantar aspect of her left foot. A surgical consultation results in a recommendation for a below-the-knee amputation, but the patient declines the procedure on the grounds that she has lived long enough and wants to die with her body intact. Her internist, . . . [Full Text of this Article]

The Clinical Problem

Strategies and Evidence

Criteria for Assessment of Decision-Making Capacity

Determining Whether Impairment Constitutes Incompetence

Approaches to Assessment

Consequences of a Finding of Incompetence

Areas of Uncertainty

Guidelines

Conclusions and Recommendations

Source Information

From the Division of Law, Ethics, and Psychiatry, Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York. Address correspondence to Dr. Appelbaum at the New York State Psychiatric Institute, Unit 122, 1051 Riverside Dr., New York, NY 10032, or at psa21@columbia.edu.

Related Letters:

Patients' Competence to Consent to Treatment
Spike J. P., Appelbaum P. S.
Extract | Full Text | PDF  
N Engl J Med 2008; 358:644, Feb 7, 2008. Correspondence

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