A combined ethics & psychiatric consultation

A case presentation is used to illustrate how psychiatrists can contribute to clinical ethics. A 75-year-old man with end-stage COPD was admitted to t he ICU. His condition deteriorated and he lost decision-making capacity wit hout expressing his wishes about end-of-life care. Although he no longer ne eded care in the ICU his surrogate decision-maker objected to his being tra nsferred. Seven months after the patient's admission an ethics consultation was carried out by a psychiatrist-ethicist. The following issues are discu ssed, elaborating on points previously made by the authors [1,2]: the absen ce of an advance directive, surrogate decision-making, the allocation of IC U beds, guidelines for discharge from the hospital, the lateness of the eth ics consultation, and the interweaving of ethical questions with psychiatri c factors. The psychiatrist-ethicist was ideally suited to address all thes e issues and to make a significant contribution to the care of the patient and his family. (C) 2001 Elsevier Science Inc. All rights reserved.