NBME 24 Determine whether the patient has decision-making capacity (NBME Answers)

NBME 24 Answers

nbme24/Block 2/Question#41 (reveal difficulty score)
A 56-year-old man who is admitted to the ...
Determine whether the patient has decision-making capacity 🔍 / 📺 / 🌳 / 📖
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submitted by ∗m-ice(370)

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Autonomy is the most important ethics principle that supersedes all others. However, it is applied only in situations in which a patient demonstrates decision-making capacity. In this situation, a patient with advanced disease unlikely to be cured is refusing treatment, which is his right under the principle of autonomy. However, his comments about "returning in 6 months after curing arthritis" are questionable, and warrant determining if he has decision making capacity. It is possible that he does, which is why any choices of forcing further treatment on him are incorrect.

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hungrybox These ethics questions seems so simple and yet somehow I always get them wrong. I guess deep down I'm just a scumbag. +20

mutteringly Hey there's always dental school +5

hungrybox legit made me lol, thanks for that +1

jurrutia Also, the patient is delusional! He thinks he's going to cure arthritis. You don't have decision making capacity when you're crazy. +1

madamestep Actually, you absolutely can have decision-making capacity when you're crazy. You just need to have a logical reason for your decision for this one decision. Also it depends on the decision: someone with AD might not have decision making capacity for their long term treatment or housing needs, but they might have decision making capacity between two drug choices being recommended. +

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submitted by ∗marypoppins(1)

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Why can't it be choice E? I assumed the patient had bipolar.

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submitted by ∗beetbox(6)

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Can someone explain more on how to tackle these types of questions? I suck at these questions for real... To me, he sounded pretty sane and reasonable (does not wish to waste other people's money). Sure he might be under slight depression judging how he has a terminal illness and his statement on how nobody cares for him. But unless he is incoherent or displaying magical thinking, signs of loss of memory etc., why should he be evaluated on decision-making capacity?

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drdoom in medical parlance, you can be so depressed that you're actually cognitively impaired. this is known as pseudodementia. thus, you need to figure out: “is this guy so depressed we can deem him incompetent to make decisions?” +

rockodude he says he has an invention to cure arthritis in 6 months he'll be back.. not normal imo. at least for this question thats the line that made me think does this person have capacity +

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