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Capacity refusal — ABEM Board MCQ

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HardPsychiatric emergenciesCapacity refusalABEM Board

A 67-year-old man with hypoxia from pneumonia wants to leave the ED. Triage acuity is ESI 2; SpO2 is 84% on room air, BP 92/58 mm Hg. He is oriented to name only, cannot explain risks of leaving, and believes staff are poisoning him. Family confirms this is new. Which of the following is the most appropriate disposition?

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Correct answer: D — Hold him for emergency treatment because he lacks decision-making capacity

Decision-making capacity requires understanding, appreciation, reasoning, and communication; delirium with inability to understand risks permits emergency treatment.

Reference: ACEP Ethics and psychiatric patient policy