Psychopharmacological treatment of delirium to restore mental capacity.

The authors report four patient cases of delirium in which medications were used to restore mental capacity when life-or-death treatment decisions were required. Although extensive literature on substituted judgment exists for delirium and depression compromising capacity to make competent decisions, the authors could locate no articles proposing aggressive delirium treatment for restoring patients' capacity to participate in their own care. Without surgical intervention, all four of the authors' patients faced imminent death. Without psychopharmacologic banishment of the patients' deliria, proxies would have been asked whether the patients should undergo potentially lifesaving but high-risk procedures. The patients would have lost the opportunity to express their wishes about heroic lifesaving medical measures.