Title: Can my patient with dementia refuse treatment?<br/>Author: Danya Khoujah<br/><a href='http://umem.org/profiles/faculty/739/'>[Click to email author]</a><hr/><p>
        <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Medical decision-making capacity refers to the patient’s ability to make informed decisions regarding their care, and emergency physicians are frequently required to assess whether a patient possess this capacity. Patients with acute or chronic neurological diseases (such as dementia) may lack this capacity, and this should be identified, especially in life-threatening situations. The patient must have the ability to:</span></span></p>
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                        <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">communicate a consistent choice</span></span></p>
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                        <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">understand (and express) the risks, benefits, alternatives and consequences</span></span></p>
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                        <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">appreciate how the information applies to the particular situation</span></span></p>
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                        <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">reason through the choices to make a decision</span></span></p>
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        <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">There are numerous tools that may help with this assessment, but none has been validated in the ED. Be careful of determining that the patient lacks capacity just because of the diagnosis they carry. </span></span></p>
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        <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;"><u><strong>BONUS PEARLS:</strong></u></span></span></p>
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                        <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Capacity is a fluid concept; a patient may have the capacity to make simple decisions but not more complex ones. Capacity may also change over time</span></span></p>
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                        <span style="font-size:14px;"><span style="font-family:arial,helvetica,sans-serif;">Psychiatry consultation to determine capacity is not obligatory but may be utilized for a second opinion.  </span></span></p>
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        <!--?xml version="1.0" encoding="UTF-8"?--><span font-size:="" font-stretch:="" helvetica="" line-height:="" style="font-family: ">Rodgers JJ, Kass JS. Assessment of Medical </span><span style="font-family: Helvetica Neue; font-size: 14px;">Decision-making </span><span style="font-family: Helvetica Neue; font-size: 14px; font-stretch: normal; line-height: normal;">Capacity in Patients </span><span style="font-family: Helvetica Neue; font-size: 14px;">With Dementia. </span> <span font-size:="" font-stretch:="" helvetica="" line-height:="" style="font-family: ">Continuum </span><span style="font-family: Helvetica Neue; font-size: 14px;">2018;24(3)</span><span style="font-family: Helvetica Neue; font-size: 14px; font-stretch: normal; line-height: normal;">:920</span><span style="font-family: Helvetica Neue; font-size: 14px; font-stretch: normal; line-height: normal;">–</span><span style="font-family: Helvetica Neue; font-size: 14px; font-stretch: normal; line-height: normal;">925.</span></p>
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