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A combined ethics & psychiatric consultation.

C P Leeman1, J Blum, M S Lederberg

  • 1Clinical Professor of Psychiatry and Faculty Associate, Division of Humanities in Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA. cp1@cpleeman.net

General Hospital Psychiatry
|April 21, 2001
PubMed
Summary

Psychiatrists can enhance clinical ethics by addressing complex end-of-life care decisions, particularly when patients lack decision-making capacity. This case highlights the value of psychiatrist-ethicists in resolving ethical dilemmas involving surrogate decision-making and hospital discharge.

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Area of Science:

  • Medical Ethics
  • Psychiatry
  • Critical Care Medicine

Background:

  • A 75-year-old male with end-stage COPD was admitted to the Intensive Care Unit (ICU).
  • The patient lost decision-making capacity without prior end-of-life care directives.
  • A surrogate decision-maker refused transfer despite the patient no longer requiring ICU care.

Observation:

  • An ethics consultation was requested seven months after admission.
  • The consultation was conducted by a psychiatrist-ethicist.
  • Key issues included lack of advance directives, surrogate objections, ICU bed allocation, and discharge guidelines.

Findings:

  • The psychiatrist-ethicist's expertise was crucial in navigating complex ethical issues.
  • Psychiatric factors were interwoven with ethical considerations.
Keywords:
Death and Euthanasia

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  • The consultation addressed the delayed ethics review and its impact.

    • Implications:

    • Psychiatrist-ethicists are well-suited to contribute to clinical ethics and patient care.
    • Early ethics consultation can prevent prolonged ethical conflicts.
    • Integrating psychiatric insights improves management of complex patient cases and family support.