Abstract
The Patient Self Determination Act (PSDA) of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient’s preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity (DMC). In general, patients are presumed to have DMC. A patient’s DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders.
Similar content being viewed by others
References
American Bar Association. (2016). Law for older Americans. http://www.americanbar.org/groups/public_education/resources/law_issues_for_consumers/patient_self_determination_act.html. Accessed 3 Oct 2016.
Appelbaum, P. S. (2007). Clinical practice. Assessment of patients’ competence to consent to treatment. New England Journal of Medicine, 357(18), 1834–1840.
Appelbaum, P. S., & Grisso, T. (1988). Assessing patients’ capacities to consent to treatment. New England Journal of Medicine, 319(25), 1635–1638.
Bloom, H. L., Shukrullah, I., Cuellar, J. R., Lloyd, M. S., Dudley, S. C., Jr., & Zafari, A. M. (2007). Long-term survival after successful inhospital cardiac arrest resuscitation. American Heart Journal, 153(5), 831–836.
Brody, B. (2009). Who has capacity? New England Journal of Medicine, 361(3), 232–233.
Campo-Engelstein, L., Jankowski, J., & Mullen, M. (2015). Should health care providers uphold the DNR of a terminally ill patient who attempts suicide? HEC Forum, 28, 169–174.
Charland, L. C. (1998). Appreciation and emotion: Theoretical reflections on the MacArthur treatment competence study. Kennedy Institute for Ethics Journal, 8(4), 359–376.
Cook, R., Pan, P., Silverman, R., & Soltys, S. M. (2010). Do-not-resuscitate orders in suicidal patients: Clinical, ethical, and legal dilemmas. Psychosomatics, 51(4), 277–282.
Coverdale, J. H., Chervenak, F. A., McCullough, L. B., & Bayer, T. (1996). Ethically justified clinically comprehensive guidelines for the management of the depressed pregnant patient. American Journal of Obstetrics and Gynecology, 174, 169–173.
Drane, J. F. (1984). Competency to give an informed consent. A model for making clinical assessments. JAMA, 252(7), 925–927.
Field, H. L. (2008). A patient with acute traumatic quadriplegia who requested a DNR order. Psychosomatics, 49(3), 252–254.
Ganzini, L., Lee, M. A., Heintz, R. T., & Bloom, J. D. (1992). Do-not-resuscitate orders for depressed psychiatric inpatients. Hospital & Community Psychiatry, 43(9), 915–919.
Mystakidou, K., Rosenfeld, B., Parpa, E., Katsouda, E., Tsilika, E., Galanos, A., et al. (2005). Desire for death near the end of life: The role of depression, anxiety and pain. General Hospital Psychiatry, 27(4), 258–262.
O’Connor, R. C., & Nock, M. K. (2014). The psychology of suicidal behaviour. Lancet Psychiatry, 1(1), 73–85.
Proposed policy, payment, and quality provisions changes to the Medicare Physician Fee Schedule for Calendar Year. (2016). http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-07-08.html.
Roberts, L. (2016). Assistance in dying: Deepening understanding of novel ethical issues in psychiatry. Clinical Psychiatry News, 51(18), 15–18.
Shnek, Z. M., Foley, F. W., LaRocca, N. G., Gordon, W. A., DeLuca, J., Schwartzman, H. G., Halper, J., Lennox, S., & Irvine, J. (1997). Helplessness, self-efficacy, cognitive distortions, and depression in multiple sclerosis and spinal cord injury. Annals of Behavioral Medicine, 19(3), 287–294.
Suominen, K., Henriksson, M., Suokas, J., Isometsä, E., Ostamo, A., & Lönnqvist, J. (1996). Mental disorders and comorbidity in attempted suicide. Acta Psychiatrica Scandinavica, 94(4), 234–240.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Brody, B.D., Meltzer, E.C., Feldman, D. et al. Assessing Decision Making Capacity for Do Not Resuscitate Requests in Depressed Patients: How to Apply the “Communication” and “Appreciation” Criteria. HEC Forum 29, 303–311 (2017). https://doi.org/10.1007/s10730-017-9323-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10730-017-9323-6