Clinical Education: Evaluating Depression in Patient Request for Termination of Medical Care

Psychologists in inpatient settings may be called upon to evaluate patients mental health when patients request to terminate interventions or refuse to engage in life- sustaining treatments. Although rates of distress are high in patients experiencing acute and chronic illness, especially as symptoms impact quality of life, less has been written on the nuances of assessing how affective symptoms may influence treatment decisions. This article describes some of the challenges health care providers may face in situations in which patients appear to be actively or passively withdrawing from care. We offer suggestions for assessment and considerations for referrals and resources to guide providers in conceptualization and intervention within these situations. This paper can ideally serve as a guide to aid psychologists to assist the medical team, the patient, and their family with appropriate decision-making regarding terminating medical care and to ensure these decisions were not unduly influenced by a potentially treatable and modifiable mood concern.