SHM Converge Scientific Abstract ePoster Gallery-The Crossroads of Conviction: An Interdisciplinary Bioethics Case

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This case describes a 48-year-old woman, QF, with heart failure, lupus nephritis, and prior lupus cerebritis who was hospitalized with severe fluid overload, renal failure, and inability to walk. Urgent dialysis was recommended, but QF refused treatment and requested discharge, stating that God would heal her. She was alert, oriented, and able to explain the risks and benefits of refusing dialysis.<br /><br />The article reviews the four core elements of decision-making capacity: expressing a choice, understanding, appreciation, and reasoning. Psychiatry evaluated QF and concluded that she lacked capacity mainly because of impaired “appreciation,” meaning she did not fully grasp how the consequences of refusing treatment applied to her own condition. The ethics committee, however, emphasized her long-standing and consistent refusal of medical care based on deeply held religious beliefs, as well as her weak social support and unstable situation.<br /><br />The committee determined that forcing treatment would likely require restraint and prolonged intervention, which would violate her dignity and conscience. Given her refusal of dialysis and lack of a suitable support system, the team and her chosen healthcare proxy decided to arrange inpatient hospice care.<br /><br />The case highlights the challenge of balancing autonomy, capacity assessment, religious conviction, and beneficence in complex bioethical situations. It underscores that formal assessment tools are important but limited, and that interdisciplinary judgment is often needed to respect the patient’s values while addressing medical risk.

Asset Subtitle

Matthew Au

Meta Tag

Author List Angel Chen, Dorothy Castro, Matthew Au

Category Clinical Vignettes

Concept Healthcare Decision-Making Capacity

Concept Communication of Choice

Concept Understanding

Concept Appreciation

Concept Reasoning

Distinguished Non-Finalist

Presenter Organization Rutgers New Jersey Medical School

Presenting Author Matthew Au

Track Adult

Keywords

decision-making capacity

dialysis refusal

heart failure

lupus nephritis

lupus cerebritis

ethics committee

religious beliefs

patient autonomy

hospice care

bioethics

Healthcare Decision-Making Capacity

Communication of Choice

Understanding

Appreciation

Reasoning