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DNR Versus DNT: Clinical Implications of a Conceptual Ambiguity: A Case Analysis

Received June 23, 2006; accepted July 6, 2006. From the Dept. of Psychiatry, Long Island Jewish Medical Center, Albert Einstein College of Medicine (RDM); the Dept. of Psychiatry, Mount Sinai School of Medicine; the Dept. of Psychiatry and Behavioral Medicine, Medical College of Wisconsin (LWR); the Dept. of Psychiatry, Mount Sinai School of Medicine (SMB); the Dept. of Psychiatry, Georgetown University Medical School (DH); and the Dept. of Psychiatry, University of California, Davis Medical Center (JAB). Send correspondence and reprint requests to Mary Ann Cohen, M.D., FAPM, Clinical Professor of Psychiatry, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1009, New York, New York 10029. e-mail: macohen{at}nyc.rr.com

Psychiatrists who practice psychosomatic medicine are routinely called upon to help resolve ethical dilemmas that arise in the care of patients near the end of their lives. Psychosomatic-medicine psychiatrists may be of unique value in these situations because of the clinical insights that we bring to the care of the dying patient. In particular, our subspecialty brings expertise related to the evaluation of decisional capacity of patients who are faced with accepting or declining end-of-life clinical interventions, such as resuscitation and intubation. In this first entry in a new bioethics case series in Psychosomatics, we will lay the groundwork for examining a complex patient case and provide an illustrative analysis of the end-of-life care issues that may be addressed by psychiatrists who practice psychosomatic medicine.

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