PSYCHIATRIC DIMENSIONS OF MEDICAL PRACTICE: COMPETENCE TO REFUSE MEDICAL ADVICE-WHEN THE EXAMINER IS UNCERTAIN: INVOLVING FAMILY MEMBERS

It is not uncommon for physicians to evaluate the competence of patients they have never met before. As in the case described above, family members can be helpful when the outcome of the evaluation is equivocal. Based on his sister’s report, Mr. B.’s reluctance to follow medical advice did not spring from a delusional belief that God would heal him. The patient’s decision-making capacity was intact, though he was understandably apprehensive about a lung biopsy and responded with characteristic irritability and obstinacy when repeatedly urged to have one.

Family members are almost always willing to compare a patient’s current way of thinking with what they have observed in the past. They cannot be asked to decide whether or not the patient is competent, but they can be asked to decide whether or not he is himself.

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PSYCHIATRIC DIMENSIONS OF MEDICAL PRACTICE: COMPETENCE TO REFUSE MEDICAL ADVICE-WHEN THE EXAMINER IS UNCERTAIN: INVOLVING FAMILY MEMBERSIt is not uncommon for physicians to evaluate the competence of patients they have never met before. As in the case described above, family members can be helpful when the outcome of the evaluation is equivocal. Based on his sister’s report, Mr. B.’s reluctance to follow medical advice did not spring from a delusional belief that God would heal him. The patient’s decision-making capacity was intact, though he was understandably apprehensive about a lung biopsy and responded with characteristic irritability and obstinacy when repeatedly urged to have one. Family members are almost always willing to compare a patient’s current way of thinking with what they have observed in the past. They cannot be asked to decide whether or not the patient is competent, but they can be asked to decide whether or not he is himself.*73\172\2*

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