Question

What predictors determine if patients are mentally competent to make their own decisions? How could a patient's decision be affected in situations where the decisions do not appear to make sense?

What are the differences between a permanent vegetative state and a coma? How do these differences affect the ethical choices faced by the family and caregivers of the patient? What importance should the patient's own wishes have? How would the presence of a living will affect the decision?

Answer 1

The predictors to determine a patient for mental competency to make own decisions are

• Able to make decision rationally
• Capable to understand what is conversed
• Has the capacity or ability to make decision in a sound mind
• Mentally fit

As per the ethics ,the principle of autonomy gives full right to a patient to make decision in regards to their healthcare treatment but in certain situations the decisions made do not make any sense.For example :a parents of Jehovah's witness refusing a blood transfusion procedure ,where the child could be survived only with this procedure suffering a fatal disease or a complication.

The differences between conan and vegetative state are

Coma	Vegetative state
Reversible Cannot be awakedned No sleep cycle Does not respond to stimuli Lasts for about a months Prevention is a better way to avoid coma Do not open eyes Life support may be needed Death can be prevented if appropriate cause is treated	Non reversible Are awake Sleep cycle is present May respond to stimuli but with no awareness Will be more than a month May open eyes Preventive measures are difficult because comes to this stage from coma No need of life support Death sill occur

In both cases the ethical choices can be affected whether to provide a treatment or not on grounds of principle of ethics.This can be a legal issue if a sound decision is not made against the patient autonomy. In these cases a advance directive can be much useful

A patient wish should be in such a way it is beneficence to them and doesn't create any problems to others both family and healthcare sector.

Living will can affect a decision in the following ways

When a patient can be retrieved with medical intervention,but the living will not requesting it or refusing it

A feeding tube insertion can prolong life but patient refusing it in living will

A CPR can retrieve the patient but patient refusing in living will