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Medline ® Abstract for Reference 28

of 'Palliative care: Issues in the intensive care unit in adults'

CURVES: a mnemonic for determining medical decision-making capacity and providing emergency treatment in the acute setting.
Chow GV, Czarny MJ, Hughes MT, Carrese JA
Chest. 2010 Feb;137(2):421-7.
The evaluation of medical decision-making capacity and provision of emergency treatment in the acute care setting may present a significant challenge for both physicians-in-training and attending physicians. Although absolutely essential to the proper care of patients, recalling criteria for decision-making capacity may prove cumbersome during a medical emergency. Likewise, the requirements for providing emergency treatment must be fulfilled. This article presents a mnemonic (CURVES: Choose and Communicate, Understand, Reason, Value, Emergency, Surrogate) that addresses the abilities a patient must possess in order to have decision-making capacity, as well as the essentials of emergency treatment. It may be used in conjunction with, or in place of, lengthier capacity-assessment tools, particularly when time is of the essence. In addition, the proposed tool assists the practitioner in deciding whether emergency treatment may be administered, and in documenting medical decisions made during an acute event.
Department of Medicine, Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University School of Medicine, Baltimore, MD 21224-2780, USA. gchow2@jhmi.edu