I am going to answer the sample USMLE Step 2 CK Questions with Explanation. These questions are available at USMLE.org
A 70-year-old woman is admitted to the hospital because of a 1–hour history of shortness of breath. She has lung cancer and dementia, Alzheimer type, and has had a decline in mental status during the past month. She lives with her boyfriend of 20 years; he has cared for her and has taken care of the home since she was diagnosed with dementia 2 years ago. She has one adult son who lives out of state, but she speaks to him on the phone daily. The patient’s neighbor, who is a nurse and a long-term friend, takes her to all medical appointments and ensures she takes her medications appropriately. The patient is unable to understand the poor prognosis of her condition. She has not designated a health care power of attorney.
Which of the following is the most appropriate person to make medical decisions for this patient?
(A) Boyfriend
(B) Neighbor
(C) Patient
(D) Physician
(E) Son
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Answer
While the neighbor may be involved in the patient’s care and may have a good understanding of her medical condition, and while the boyfriend has been her primary caregiver, when it comes to making medical decisions for a patient who lacks the capacity to make decisions themselves, legal considerations become paramount.
In this scenario, the patient lacks the capacity to make medical decisions due to advanced dementia, as indicated by her decline in mental status. Without a designated healthcare proxy or power of attorney for healthcare decisions, the responsibility typically falls to the closest family member or next of kin.
The patient’s son, although living out of state, maintains regular contact with the patient and speaks to her on the phone daily. He is also her adult child, which typically places him in the role of the closest family member. The son can discuss her situation with the neighbor and boyfriend to make a clear decision about his mother. Additionally, there is no indication in the scenario that the patient has a strained relationship with her son or that there are any legal constraints preventing him from assuming the role of decision-maker.
Therefore, given the patient’s lack of capacity to make decisions, and in the absence of a designated healthcare proxy or power of attorney for healthcare decisions, the son would be the most appropriate person to make medical decisions on behalf of the patient, as he is the closest family member and maintains regular contact with her.
The correct answer is (E) Son
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