Life and death decisions in the middle of the night: teaching the assessment of decision-making capacity.

摘要

At 2:00 AM one morning, when I was a much younger attending physician, I received a call from a resident on service in the ICU. He called about a case with "an FYI," because he had a few minutes and thought I might want to be informed. He told me of a 25-year-old man admitted that night with what appeared to be severe community-acquired pneumonia. The patient carried the diagnosis of developmental delay, but, the resident informed me, the patient had been previously determined to be legally competent to make his own decisions by the courts, and he lived alone. The patient was developing acute respiratory failure, and he refused intubation and mechanical ventilation.