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Treatment refusal without capacity — USMLE Step 3 MCQ

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HardEthics, Patient Safety, Quality Improvement, Systems-Based PracticeTreatment refusal without capacityUSMLE Step 3

A hospitalized patient with schizophrenia refuses antibiotics for pneumonia because he believes the pills contain cameras. He cannot explain the illness or the consequences of refusal. What is the best next step?

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Correct answer: B — Assess capacity and use surrogate or emergency authority if needed for treatment

Capacity is decision-specific and requires understanding, appreciation, reasoning, and communication. This delusion prevents appreciation of relevant facts; clinicians should document incapacity and use the proper surrogate or emergency pathway.

Reference: American Medical Association, Code of Medical Ethics: Decisions for Adult Patients Who Lack Capacity: https://code-medical-ethics.ama-assn.org/ethics-opinions/decisions-adult-patients-who-lack-capacity