General Hospital Psychiatry
Volume 25, Issue 2 , Pages 130-135, March 2003

Decision-making capacity and alcohol abuse: clinical and ethical considerations in personal care choices☆

  • Lara D. Hazelton, MD, FRCP(C)

      Affiliations

    • Department of Psychiatry, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
    • Corresponding Author InformationCorresponding author. Tel.: +902-473-2492; fax: +902-473-1422.
    • ,
  • Gwenyth L. Sterns, MSc, R.Psych

      Affiliations

    • Department of Psychology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
    • ,
  • Terry Chisholm, MD, FRCP(C)

      Affiliations

    • Department of Psychiatry, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada

Abstract 

Requests for competency assessment of elderly patients are among the more common referrals that medical and surgical units make to consultation-liaison psychiatrists. Special considerations arise when impairment in cognition, judgment and function arise in the context of substance abuse. At what point during the admission should the evaluation be made? What if the person does well on the cognitive exam but has shown repeated evidence of self-neglect and need for medical care? What role should the medical profession play in mandating that patients give up harmful addictions? In this paper, we describe a case that illustrates these problems, and discuss some of the clinical and ethical considerations involved in the assessment of personal care competence of patients with alcohol abuse, and provide guidelines for these assessments.

Keywords: Capacity, Competency, Alcohol, Abuse

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☆ The growing complexity of medical care and practice has increasingly brought a number of otherwise independent disciplines into closer working relationships for purposes of mutal education and problem solving. This process is prominently visible in the ways law, ethics, and psychiatry intersect around patient care in the general medical and hospital setting. This special section will publish informative and provocative articles which address these vital matters.

PII: S0163-8343(03)00005-7

doi:10.1016/S0163-8343(03)00005-7

General Hospital Psychiatry
Volume 25, Issue 2 , Pages 130-135, March 2003

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