# Decision-Making Capacity in a Transgender Patient With Schizophrenia and Concerns for a Life-Threatening Skin Infection

## TL;DR

This case study explores the ethical challenges of assessing decision-making capacity in a transgender man with schizophrenia and a severe skin infection.

## Contribution

The paper highlights the complexities of balancing patient autonomy and medical necessity in psychiatric care.

## Key findings

- Assessing decision-making capacity is ethically challenging in patients with severe mental illness and comorbid medical conditions.
- Cultural, educational, and linguistic barriers complicate care for transgender individuals with schizophrenia.
- Respecting patient autonomy while ensuring appropriate treatment requires nuanced clinical judgment.

## Abstract

Assessing patient decision-making capacity while adhering to the requests of patients with mental illness remains a great ethical challenge. In patients with severe mental illness, the assessment of decision-making capacity can be difficult, particularly when a care team is also trying to navigate cultural, educational, and linguistic barriers. It becomes especially complex in situations where the patient is not only diagnosed with a severe mental illness but also suffers from a comorbid medical illness that the patient refuses to have treated appropriately. Balancing patient wishes while respecting patient autonomy creates further issues when assessing decision-making capacity. As such, the following case presents a transgender man who suffers from schizophrenia with a persistent skin infection on the patient’s torso secondary to wearing a brassiere for an extended period. This case report addresses the intricacies surrounding patient decision-making capacity, specifically in the psychiatric population.