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Medical Ethics |

CURVES: A Mnemonic for Determining Medical Decision-Making Capacity and Providing Emergency Treatment in the Acute Setting

Grant V. Chow, MD; Matthew J. Czarny, BS; Mark T. Hughes, MD, MA; Joseph A. Carrese, MD, MPH
Author and Funding Information

From the Department of Medicine and the Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University School of Medicine. Baltimore, MD.

Correspondence to: Grant Chow, MD, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD 21224-2780; e-mail: gchow2@jhmi.edu


For editorial comment see page 248

Editor's note: To view articles included in the core curriculum of the ongoing Medical Ethics series, visit http://chestjournal.chestpubs.org/cgi/collection/medethics. —Constantine A. Manthous, MD, FCCP, Section Editor, Medical Ethics

Funding/Support: Drs Carrese and Hughes are supported by the Morton K. and Jane Blaustein Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(2):421-427. doi:10.1378/chest.09-1133
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The evaluation of medical decision-making capacity and provision of emergency treatment in the acute care setting may present a significant challenge for both physicians-in-training and attending physicians. Although absolutely essential to the proper care of patients, recalling criteria for decision-making capacity may prove cumbersome during a medical emergency. Likewise, the requirements for providing emergency treatment must be fulfilled. This article presents a mnemonic (CURVES: Choose and Communicate, Understand, Reason, Value, Emergency, Surrogate) that addresses the abilities a patient must possess in order to have decision-making capacity, as well as the essentials of emergency treatment. It may be used in conjunction with, or in place of, lengthier capacity-assessment tools, particularly when time is of the essence. In addition, the proposed tool assists the practitioner in deciding whether emergency treatment may be administered, and in documenting medical decisions made during an acute event.

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