Forensic issues in critical care medicine

This chapter provides an overview of legal and ethical considerations relevant to the diagnosis and treatment of psychiatric illness in critically ill patients. Practical aspects of obtaining patients' informed consent, maintaining confidentially, and seeking additional consultation are emphasized. Special problems in the management of patients who are dangerous to themselves, are minors, and have human immunodeficiency virus infection (HIV) are discussed. Difficulties that arise when patients refuse treatment and when such patients' competency must be determined are also enumerated. Finally, approaches to dealing with irreversibly incompetent and comatose patients are described. The author contends that the law cannot or does not provide answers to several enigmas clinicians may encounter, such as the manner in which physicians should respond when a patient with a terminal illness does not want his/her family to known or when a patient with HIV infection is unwilling to inform his sexual partner. When appropriate, recommendations for dealing with these situations are given.