Mr. Sakiewiec is a 32-year-old man with severe mental retardation who has been institutionalized since childhood. He is noncommunicative and has never been able to verbalize his preferences on any decision. His parents are dead and the institution and a court-appointed guardian manages him. He has developed leukemia that is severe and incurable. Chemotherapy involves significant risk and discomfort and only a small chance of prolonging his survival. What should be done in terms of his medical treatment?

Correct Answer: D

Rationale: This patient has never been competent so there is no possibility of trying to determine what he had wanted for himself. There is no family to act in his best interests. You cannot substitute judgment for a person that has never had judgment. This case involves decision making on the least accurate of the decision-making standard, which is to determine what would be in the best interests of the patient. The reason this is the least accurate method of giving or withholding consent is that there is no way to be sure what the patient would have wanted for himself. With a best interests standard we have the difficult problem of determining whether the guardian is basing their decision on what the patient would need, or the guardian's own subjective standard of what they would want for themselves. In this case, the burden of therapy for no chance of cure is worse than the option of simply deferring therapy. If there is a court-appointed guardian, then there is no point of an 'expert panel.' The question here is not one of what the best medical therapy is, but what is in the best interests of a patient too mentally impaired to make his own decisions.

Correct Answer: B

Rationale: Smoking increases cardiovascular risks with birth control pills, making cessation critical.

Correct Answer: D

Rationale: Amitriptyline is a tricyclic antidepressant used for depression.

Correct Answer: B

Rationale: Tardive dyskinesia is a severe, often irreversible movement disorder from long-term psychotropic use.

Correct Answer: C

Rationale: Hypoglycemia causes headache and confusion due to low glucose in the brain.