Extract
A ninety-four-year-old woman who lived alone fell in her
home. She presented to our emergency room with a displaced fracture
of the femoral neck. Surgical treatment with hemiarthroplasty was
recommended. The patient adamantly refused surgery. The risks and
benefits of a hemiarthroplasty were explained, as were the severe
limitations and impairments of an untreated hip fracture. She persisted
in her refusal. Specific questions answered by the patient indicated
that she clearly understood the diagnosis and the proposed treatment
plan. However, she believed that she could return to her home with
the untreated hip fracture and continue to function independently. Multiple
attempts to explain to her that she would be unable to walk, let
alone care for herself, were unsuccessful. At this point, her medical
attending physician requested a consultation from liaison psychiatry.
The psychiatrist decided that the patient had the capacity to refuse
hip surgery. Nevertheless, the patient agreed to remain in the hospital. She
was admitted to the orthopaedic service and was placed in skin traction pending
intervention from social services. Within twenty-four hours, the pain
worsened and the patient requested surgical intervention.