Volume 196 - Issue 5
Competence and capacity at the end of life: uneasy paternalism
Authors: Brian H Le and Michael D Chapman
Med J Aust 2012; 196 (5): 312. || doi: 10.5694/mja12.10209
Published online: 19 March 2012
Published online: 19 March 2012
In reply: We thank Reutens and Peisah for their response to our article.1 We agree that careful capacity assessment is of critical importance — a patient’s capacity should be assessed rather than assumed.
Delirium can often affect capacity due to the impact of attentional deficit on the process of decision making.2 In our case, the patient could neither reason through the ramifications of his decision to stay on the floor nor be involved in a logical discussion as to why we had concerns about his choice. Indeed, he had not chosen to be on the floor but was there because of his fall, his delirium and his inability to rise.
However, we do caution that clinicians should trust their own clinical decisions when these are based on sound assessment. Choosing not to make hard decisions for fear of litigation (eg, committing trespass) does neither the patient, the community nor our profession any favours.
Competing interests
No relevant disclosures.
References
- Le BH, Chapman MD. Competence and capacity at the end of life: uneasy paternalism. Med J Aust 2011; 195: 476-477. <eMJA full text>
- Adamis D, Martin FC, Treloar A, Macdonald AJD. Capacity, consent and selection bias in a study of delirium. J Med Ethics 2005; 31: 137-143. 0_i1142858