The article’s beginning addresses a seventy-five-year-old woman with diabetes mellitus and a gangrenous ulcer on her foot, who is unwilling to get surgery that would result in an amputation below the left knee. The patient shares that due to living a long life, she does not agree with the surgery, does not want any portion of her body removed, and would like to die with her “Body Intact”. According to the law and the medical code of ethics, physicians must obtain informed consent. Once the latter is made, it is under validity; patients can make voluntary care choices for themselves; if this is not possible, a substitute person will make the appropriate decision.
Determining a client’s ability to make clinical decisions that are effective for them is the responsibility of the appropriate professional. They need to assume responsibility for all medical steps if the person’s inability to participate in prescribing treatment fully is proven. The court usually determines a lack of competence; this expertise takes a considerable amount of time and causes a pause in the medical process. Specialists clearly distinguish between competence and capacity since the former is a legal concept and the latter is considered in a medical context.
Patients suspected of being incompetent are usually observed in inpatient units. Observation of these individuals requires the inclusion of psychotherapists in 25% of cases (Appelbaum 1839). Incompetence is typical among patients with Alzheimer’s disease and dementia. With varying degrees of these diagnoses, the likelihood of being unable to make decisions about therapy is also high. Another factor influencing the loss of competence is a stroke. It can lead to a partial inability to make medical decisions and requires special examination procedures.
A patient’s inability to make independent decisions must be determined promptly by specialists. Particular care must be taken when collecting data and interviewing patients. If the hospital staff does not take such measures, the quality of treatment becomes minimized. The patient may lose the chance to receive the most effective therapy for the particular case. In the case of proven non-competence, hospital clients are still provided with an acceptable alternative and all necessary information about the medical interventions being performed. Practice with such patients is governed by the principle of respect and protection from adverse decisions and consequences (Appelbaum 1840). Regardless of which body makes therapeutic decisions instead of incapacitated people, they are legally guaranteed safety of life and high quality of treatment.
When evaluating, informed consent is relevant to the patient’s interaction with the therapist. In many cases, competency testing needs to be performed already when a person is hospitalized and is incompetent during prolonged treatment (Appelbaum 1838). Physicians then typically use the Mini-Mental Screening Exam (MMSE), which is associated with the clinical judgment of incompetence, along with determining the ranges of incompetence common in the elderly population.
The MMSE score can range from 2 to 30; lower scores indicate cognitive impairment. This scale also provides a measure of incompetence. Another test used more frequently is the McArthur Competence Assessment Tool. This screening is more specific because it examines real-time decision-making quality (Appelbaum 1839). This kind of monitoring combines qualitative and quantitative measures. At the same time, from the organizational point of view, it is convenient because it does not take more than 20 minutes (Appelbaum 1840). This monitoring can only be carried out by highly qualified and experienced professionals who can guarantee that the result is accurate and of value.
During the evaluation, patients must get the data that allows an informed decision to be made regarding their treatment. The latter includes the health conditions, the purpose of the treatment, the benefits and risks, information about what alternative therapies may be available, and what actions will be taken if treatment is denied. The physician should allow time for two different evaluations, accompanied by staff and family members of the patient (Appelbaum 1838). In addition, due consideration should be given to informing hospital clients of the purpose of the evaluation. Besides, physicians should make sure that all the steps presupposed by a certain therapy strategy are clear for everyone. Regarding the consequences of admitting incompetence, it is best to make sure that the patient’s medical condition is urgent and offer alternatives as well as treatment options if necessary.
Many patients with cognitive impairment are provided with medical support that can return them to their previous level of competence. If this does not happen and the hospital client continues to demonstrate an inability to make decisions, then consent to treatment and advance directives are obtained. In the absence of a note from the patient, family members should be contacted. In doing so, the professional should understand which family member it is appropriate to contact. Incapacitated patients are entitled to assistance in recovering lost documents, as well as receiving free legal tapers. In disputed situations, courts may be involved to prescribe and assist in the decision-making process on behalf of patients.
Work Cited
Appelbaum, Paul S. “Assessment of Patients’ Competence to Consent to Treatment.”New England Journal of Medicine, vol. 357, no. 18, 2007, pp. 1834–40. Crossref.