A case presentation is used to illustrate how psychiatrists can contribute to clinical ethics. A 75-year-old man with end-stage COPD was admitted to the ICU. His condition deteriorated and he lost decision-making capacity without expressing his wishes about end-of-life care. Although he no longer needed care in the ICU his surrogate decision-maker objected to his being transferred. Seven months after the patient’s admission an ethics consultation was carried out by a psychiatrist-ethicist. The following issues are discussed, elaborating on points previously made by the authors [1Leeman C.P. Psychiatric consultations and ethics consultationssimilarities and differences General Hospital Psychiatry 2000 ;  22 : 270-275 [inter-ref]

Cliquez ici pour aller à la section Références, 2Lederberg M.S. Making a situational diagnosispsychiatrists at the interface of psychiatry and ethics in the consultation-liaison setting Psychosomatics 1997 ;  38 : 327-338 [cross-ref]

Cliquez ici pour aller à la section Références]: the absence of an advance directive, surrogate decision-making, the allocation of ICU beds, guidelines for discharge from the hospital, the lateness of the ethics consultation, and the interweaving of ethical questions with psychiatric factors. The psychiatrist-ethicist was ideally suited to address all these issues and to make a significant contribution to the care of the patient and his family.