A 43-year-old man is brought to the emergency department after suffering serious injuries during a fight at a local bar. The patient smells heavily of alcohol, slurs his words, and has difficulty standing and walking. It is unclear if he experienced a loss of consciousness. Physical examination reveals numerous contusions and lacerations on his face that will require suturing. The patient has unilateral pupil dilation in the right eye and appears sleepy. When he is told that a head CT scan is needed for further evaluation, he rouses and becomes belligerent. The patient begins to shout and curse, claiming that the staff is harassing him and that he will sue the hospital for violation of his civil rights. Which of the following is the most appropriate course of action?

Question

A 43-year-old man is brought to the emergency department after suffering serious injuries during a fight at a local bar.  The patient smells heavily of alcohol, slurs his words, and has difficulty standing and walking.  It is unclear if he experienced a loss of consciousness.  Physical examination reveals numerous contusions and lacerations on his face that will require suturing.  The patient has unilateral pupil dilation in the right eye and appears sleepy.  When he is told that a head CT scan is needed for further evaluation, he rouses and becomes belligerent.  The patient begins to shout and curse, claiming that the staff is harassing him and that he will sue the hospital for violation of his civil rights.  Which of the following is the most appropriate course of action?

Quizplus · Accepted Answer

Explanation: In emergency situations, patients who lack decision-making capacity may be treated without formal consent under the doctrine of implied consent. Implied consent allows physicians to provide such treatments to an incapacitated patient that a "reasonable person" would be expected to accept under similar circumstances. This patient's level of intoxication has rendered him incapacitated as evidenced by his inability to adequately demonstrate comprehension of his condition, understand the treatments offered, or express an elected course of action. His injuries are potentially life-threatening, given his anisocoria and altered level of consciousness in the setting of head trauma. Therefore, he may be treated without obtaining formal consent under the implied consent doctrine. (Choices B, C, D, and E) Because the patient has evidence of emergent, life-threatening injuries, a delay in treatment or a premature discharge would place him at unacceptable risk. If this were a nonemergency situation and the patient lacked decision-making capacity, the physician would have to pursue a surrogate decision maker (eg, next of kin, guardian). Educational objective: Patients who lack decision-making capacity and require emergency treatment may be treated under the doctrine of implied consent, which allows treatment that a reasonable person in a similar situation would be expected to accept. References: Ethical considerations in consenting critically ill patients for bedside clinical care and research. (http://www.ncbi.nlm.nih.gov/pubmed/24019298) Assessment of decision-making capacity: views and experiences of consultation psychiatrists. (http://www.ncbi.nlm.nih.gov/pubmed/23194935) Assessing decision-making capacity at end of life. (http://www.ncbi.nlm.nih.gov/pubmed/24698057)

A 43-Year-Old Man Is Brought to the Emergency Department After