|
|
 | |||
|
|
|
|
| |||
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,
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
This article has been cited by other articles:
HOME | SUBSCRIBE | SEARCH | CURRENT ISSUE | PAST ISSUES | COLLECTIONS | PRIVACY | HELP | beta.nejm.org Comments and questions? Please contact us. The New England Journal of Medicine is owned, published, and copyrighted © 2008 Massachusetts Medical Society. All rights reserved. |
Previous
