Competency is a legal term and determination of competency ultimately lies with the judicial system. All adult patients are considered competent unless specifically proven otherwise in a court of law. Physicians, however, can determine whether a patient has the capacity to properly comprehend his/her medical condition through neurological examinations including testing memory, comprehension, reasoning, and judgment. Furthermore, laboratory studies can be used to determine any organic abnormalities to determine any underlying pathology which may affect a patient’s capacity.

Q1 A 30-year-old man in a motor vehicle accident presents to the emergency department. After extended resuscitation efforts, he develops anoxia. Poor neurological prognosis, his inability to regain consciousness was determined. The patient has no advanced directive and his spouse claims that the patient said that he would not want to be kept alive if he could not interact with his family.

What is the next step in management?
A-risk management evaluation
B-patient’s medical condition
C-patient’s best interest
D-patient’s previously expressed wishes

Q2 A 30-year-old female presents in her last trimester. Her obstetrician has recommended a C-section given the large size of the fetus in comparison to the patient’s pelvis. Patient declines going through surgery despite her full understanding of the procedure due to associated pain. She is informed that fetus may not survive without the C-section.

What is the most appropriate decision-making process?
A – psychiatric evaluation
B -obtained a court order perform the surgery
C-discuss this matter with the baby’s father asked for consent to perform surgery
D- honor the patient’s wishes

Q3 A72-year-old man is evaluated for colon cancer metastasized to liver. Chemotherapy is could extend the patient’s life by 12 to 18 months. The patient has mild dementia which started 18 months ago, and his wife has now manages family finances and driving. A Mini– Mental State Examination reveals a score of 22. The risk and benefits of chemotherapy and alternative treatments are explained to the patient and his wife.

Which is the best way to determine chemotherapy treatment for this patient?
A- Ask the patient if he wants chemotherapyB- Ask the patient if he wants chemotherapy now and ask him again laterC- Ask the patient to repeat the key benefits and risks of chemotherapy
D- Ask the patient why he does or does not want chemotherapy E- Defer decision to the patient’s wife