A woman aged 79 years enters the emergency department with acute confusion. She has no other health problems and lives independently with her husband at home. Recently diagnosed with multiple myeloma by her primary-care physician, the woman has refused chemotherapy because she doesn’t want her hair to fall out. What can be done? — Jeannine Petit, RN, MS, GNP, Milwaukee

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First, determine the underlying cause of this patient’s acute confusion and treat it. Acute confusion can be caused by infection, a change in medications, an underlying medical condition and a number of other factors. A second concern is her capacity to consent to treatment. Illness or medications may impair one’s ability to make health decisions.

If the patient has been deemed competent and understands the medical diagnosis, prognosis, nature of the recommended care, alternatives to the course of care (including the risks and benefits of each), then he or she has the right to refuse treatment. This patient may have reasons or concerns beyond the loss of hair that have not been thoroughly explored. While someone else may need to make decisions during her period of confusion, her clearly stated decision regarding treatment for multiple myeloma must be respected at this time. — Deborah L. Cross, MPH, CRNP, ANP-BC, associate program director, adult NP and gerontology NP programs, University of Pennsylvania School of Nursing, Philadelphia (151-6)

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