The following case report illustrates the use of a psychiatric advance directive in a surgical setting.
Method:
The case of a woman with breast cancer and debilitating pre-operative anxiety is presented. Her anxiety was so severe that it resulted in repeated refusal to have necessary surgery. An advance directive facilitated proceeding with surgery despite her objections in the immediate pre-operative period.
Conclusion:
Consultation-Liaison psychiatrists should consider the use of an advance directive when preoperative anxiety interferes with decision-making capacity.
HowiesonB. D. and LezakM. D., The Neuropsychological Evaluation, in The American Psychiatric Press Textbook of Neuropsychiatry, Second Edition, YudofskyS. C. and HalesR. E. (eds.), American Psychiatric Press, Washington, Chapter Five, 1992.
3.
BrockE. W. and WartmanS. A.When Competent Patients Make Irrational Choices, New England Journal of Medicine, 322: 1595–1599, 1990.
4.
AppelbaumP. S.Advance Directives for Psychiatric Treatment, Hospital and Community Psychiatry, 42: 983–984, 1991.
5.
SimonR. I., Clinical Psychiatry and the Law, Chapter 6, (2nd Edition), 1992.
6.
SurmanO. S., The Surgical Patient, Massachusetts General Hospital Handbook of General Hospital Psychiatry, (3rd Edition), Mosby, St. Louis, 1991.
7.
An Act Providing for the Execution of Health Care Proxies by Individuals, Commonwealth of Massachusetts General Laws Chapter 201-D, 1990.
8.
District of Columbia Code Ann. 6–2424(a) (1989).
9.
District of Columbia Code Ann. 21–2211 (1989).
10.
Anonymous, Questions of Limits Arise Over Advance Directives, Hospital Ethics, pp. 8–11, March/April 1992.
11.
WolfS. M.BoyleP.CallahanD.FinsJ. J., and JenningsB.Sources of Concern about the Patient Self-Determination Act, New England Journal of Medicine, 323: 1666–1671, 1991.
