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Palliative Medicine
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Determining the decision-making capacity of a patient who refused food and water

Stanley A Terman

Peaceful Transitions®, San Diego, California

A terminal patient expressed the wish to hasten her death and refused nutrition. The psychiatrist asked to render an opinion relevant to her competence employed questions in a semi-structured interview derived from a new instrument originally designed to determine competence to create ‘Advance Directives’. Although the patient ultimately demonstrated her resolve by totally ceasing fluid intake, the complexity of the case–including the question of the stability of her choice–illustrates the need for specific patient safeguards.

Key Words: biothics • palliative care • dehydration • mental competency • terminally ill • euthanasia (passive)

Palliative Medicine, Vol. 15, No. 1, 55-60 (2001)
DOI: 10.1191/026921601672818272
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