Capacity consult, chronic delusions, refusing pacemaker

Patient in their 60s with schizophrenia, meds optimized on Invega Sustenna, stable at ALF for years. Has chronic delusions of being monitored, doesn't trust machines. Then he started passing out, admitted to the hospital, found to have frequent runs of asystole and cardiology recommends pacemaker. He doesn't want it (it's a machine, of course). He lacks decisional capacity. High likelihood of death without it. What do you think should happen with someone like this. Other than refusing care... Read more
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Psychiatry Source Type: forums