Related Experiment Video
Updated: Aug 21, 2025

Quantifying Cognitive Decrements Caused by Cranial Radiotherapy
Published on: October 18, 2011
A Standardized Approach to Treatment Over Objection in Patients Lacking Decision-Making Capacity Secondary to
Jeremy Ader1, Marc L Otten1, Adam Critchfield1
1Department of Neurology (JA), Columbia University Irving Medical Center; Department of Neurosurgery (MLO), Columbia University Irving Medical Center; Department of Consultation-Liaison Psychiatry (AC), Columbia University Irving Medical Center; and Department of Medicine (KMP), Columbia University Irving Medical Center.
Abstract:
Neurologic diseases, ranging from Alzheimer dementia to mass lesions in the frontal lobe, may impair decision making. When patients with neurologic disease lack decision-making capacity, but refuse treatment, should they be treated over their objection? To address this type of ethical dilemma in medical illness, Rubin and Prager developed a standardized 7-question approach: (1) How imminent is harm without intervention? (2) What is the likely severity of harm without intervention? (3) What are the risks of intervention? (4) What are the logistics of treating over objection? (5) What is the efficacy of the proposed intervention? (6) What is the likely emotional effect of a coerced intervention? (7) What is the patient's reason for refusal? We describe the application of the standardized Rubin/Prager approach as a checklist to the case of a 50-year-old woman with a large frontal lobe meningioma, who lacked capacity as a result of the meningioma, but refused surgery. This approach may be applied to similar ethical dilemmas of treatment over objection in patients lacking capacity as a result of neurologic disease.
More Related Videos
07:42Dual-Task Stroop Paradigm for Detecting Cognitive Deficits in High-Functioning Stroke Patients
Published on: December 16, 2022
08:53Randomized, Triple-Blind, and Parallel-Controlled Trial of Transcranial Direct Current Stimulation for Cognitive Rehabilitation after Stroke
Published on: June 6, 2025
Related Concept Videos
Alzheimer's Disease: Treatment
Psychosurgery
Historical Development of Psychosurgery
In the 1930s, Portuguese neurologist Antonio Egas Moniz introduced a surgical procedure designed...
Ethical Dilemmas II
Treatment Strategies for Psychological Disorders
Psychological therapies focus on modifying emotions, thoughts, and behaviors through talking, interpreting, listening, rewarding, challenging, and modeling. Clinical psychologists, counselors, and social workers commonly practice psychotherapy. Clinical...
Parkinson's Disease: Treatment
Parkinson's Disease is primarily a result of the loss of dopaminergic neurons in the substantia nigra pars compacta. The cornerstone of...
Ethical Issues
Ethical Concerns in Healthcare: