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Bioethics memory aid can help assess patient decision-making capacity in medical emergencies
Date:2/5/2010

ed."[For instance, one popular medical mnemonic is ABCD, which stands for the various treatment options for a heart attack: aspirin, beta blockers, clot busters and dynamite (nitrates).]

The original idea for CURVES emerged during an educational conference for residents and medical students on clinical ethics led and taught by Carrese. At the conference, Grant Chow, M.D., an internal medicine resident at Johns Hopkins Bayview Medical Center, shared the dilemma he faced with two emergency patients.

Chow then presented the acronym to Carrese, and the two, along with medical student Matthew Czarny and Assistant Professor of Medicine Mark Hughes, M.D., demonstrated the mental checklist in their paper via two challenging scenarios based on the cases Chow shared at the conference.

In the first scenario, an 84-year-old woman with a history of severe, chronic obstructive pulmonary disease is showing symptoms that indicate her condition could soon kill her. She is told that she should be admitted and treated with noninvasive positive pressure ventilation, intubation or comfort care. Instead, she says, "I want to die at home. Please, let me go home."

In the second scenario, a morbidly obese, 53-year-old man is admitted for suspected obesity hypoventilation syndrome and obstructive sleep apnea. At one point, he passes out and stops breathing, but is soon resuscitated. His breathing remains weak, and his head begins to bob. A medical team prepares to intubate him to stabilize his breathing, but the patient blurts out, "I don't want a tube! No tube!"

The checklist reminds practitioners how to quickly assess each patient's decision-making capacity, before acting on their own decision about which treatment option is in their patients' best interests:

C Can the patient freely choose from among the different treatment options? Are they also able to communicate their preference, either verbally, in writing or through the use of s
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Contact: Michael Pena
mpena@jhsph.edu
410-625-7872
Johns Hopkins Medical Institutions
Source:Eurekalert

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