Ethical Issues: The Patient’s Capacity to Make Medical Decisions

Although not always formally trained in ethics, consultation-liaison (C/L) psychiatrists and psychosomatic medicine physicians who practice in general hospitals frequently see cases laden with ethical questions. In a 2006 survey of members of the Academy of Psychosomatic Medicine, the majority of respondents reported that management of bioethical dilemmas had a significant effect on their work; capacity evaluation and informed consent made up the majority of the issues.1 In fact, evaluation of the patient’s decisional capacity is one of the most common consultation requests in acute hospital settings. In such situations, the primary team and other hospital staff (eg, case manager, social worker) often look to psychiatry to provide the recommendations that can affect the patient’s course of treatment and outcomes.