In their article published in Psychiatric Times titled Medical Decision-Making Capacity of Patients With Dementia, Abigail Dahan, MD, and Spencer Eth, MD, describe an elderly woman with depression who refuses medication. Based on the 4 criteria for capacity competencies model, consider the patient's ability to consent to treatment.
Mrs E, who is 80 years old, lives in the community with the help of a 24-hour-a-day home health aide. She is forgetful and requires assistance with many activities of daily living.
Mrs E is brought in for evaluation because she has been crying more frequently. She remains in bed for most of the day, does not engage in activities she used to enjoy, and is sleeping and eating less than usual. The doctor recommends a trial of an antidepressant, which Mrs E refuses. She states, “I’m 80 years old and I’m not about to start taking medications now. That would kill me!”
How can Mrs E's doctor determine whether she has the capacity to refuse treatment for depression?
Weigh in with your comments below. Drs Dahan and Eth will review your responses and give their feedback in coming weeks.