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Life and Death Decisions in the Middle of the Night: Teaching the Assessment of Decision-Making Capacity

J. Randall Curtis, MD, MPH, FCCP
Author and Funding Information

From Harborview Medical Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, University of Washington.

Correspondence to: J. Randall Curtis, MD, MPH, FCCP, Division of Pulmonary and Critical Care Medicine, University of Washington, Harborview Medical Center, Box 359762, 325 Ninth Ave, Seattle, WA 98104-2499; e-mail: jrc@u.washington.edu


Financial/nonfinancial disclosures: The author has reported to the CHEST the following confl ict of interest: Dr Curtis receives research funding from the National Institutes of Health (National Institute of Nursing Research and National Heart Lung and Blood Institute). Dr Curtis is also the President of the American Thoracic Society.

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):248-250. doi:10.1378/chest.09-1634
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At 2:00 am one morning, when I was a much younger attending physician, I received a call from a resident on service in the ICU. He called about a case with “an FYI,” because he had a few minutes and thought I might want to be informed. He told me of a 25-year-old man admitted that night with what appeared to be severe community-acquired pneumonia. The patient carried the diagnosis of developmental delay, but, the resident informed me, the patient had been previously determined to be legally competent to make his own decisions by the courts, and he lived alone. The patient was developing acute respiratory failure, and he refused intubation and mechanical ventilation. The resident informed the patient that he would likely die without this treatment, and the patient told the resident that he understood. The resident tried noninvasive ventilation, and the patient refused it. The resident was calling to tell me that he was planning to transition to comfort measures only. The team had tried unsuccessfully to reach the patient’s parents, although the social worker was still trying.

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