Aiding Decision-Making among Cognitively Compromised Young Adults Living with HIV

Objectives:

1. Increase knowledge and practice by working with medical, mental health and legal professionals to maintain a climate of mutual respect and shared values.
2. Increase knowledge and practice by using discipline-specific knowledge and knowledge of other professions to address the health care and legal needs of patients.
3. Increase confidence of participants to collaborate with other professions when necessary to address health and legal issues for patients, and to appreciate the benefits of an interdisciplinary team approach to problem-solving and counseling patients.

Activity Description

This session grew out of real cases involving urban youth living with HIV and cognitive limitations who, at age 21, age out of the public child welfare system.  As legal adults free from the oversight provided by the child welfare system, youth with limited decision-making capacity have the authority and responsibility to make medical decisions without an institutional or other support system in place to assist them.  This session will begin by exploring the medical, psycho-social, legal, and ethical issues impacting a patient with diminished capacity to give informed consent to medical treatment including the disproportionate impact of cognitive limitations in patients diagnosed with HIV before the advent of highly active antiretroviral therapy (HAART); the ethical and other issues confronting medical providers in determining patient competency; the legal tools available to assist with medical decision-making and life planning; and the ethical issues impacting medical and legal professionals.  Participants will then be introduced to a fictional 21-year old patient living with HIV, with limited cognitive abilities, and who recently aged out of the child welfare system having spent most of his life in foster care.  Participants will work in both interprofessional and discipline-specific groups to identify patient needs and obstacles surrounding consenting to medical care, ethical challenges for providers, possible solutions, and patient counseling.  Participants will role-play their interactions with professionals and the client, and will provide constructive feedback and share reflections.  The session will conclude with a discussion of the decisions made and outcomes in the real patient cases upon which the case study is based.