The Unbefriended Patient: An Ethical Balancing Act.

A 44-year-old man with untreated schizoaffective disorder is diagnosed with diffusely metastatic colon cancer. Inpatient psychiatry consultants confirmed that he lacked capacity for medical decision-making, and advised against initiating anti-psychotic medications due to concerns about intolerable adverse effects. He is unbefriended and neither a candidate for home hospice (lacking support at home), nor placement at a hospice-capable facility (being uninsured). Beauchamp and Childress' four principles have been widely applied in medical ethics. Though this model proves effective when patients or their proxies have the capacity to communicate their wishes, it is a more limited framework when patients are incapacitated and lack a proxy. The Four Box Model otherwise known as the Four Quadrant Model or Four Topics Approach, may aid physicians in the decisionmaking process when they are faced with these difficult situations. [ABSTRACT FROM AUTHOR]