Despite challenges of decision making for unrepresented patients, few laws or policy statements offer solutions. This article offers 5 key things to do.

Questions about who should make decisions for unrepresented patients prompts consideration of which and whose values should inform those decisions.

A UPAC is an alternative to engaging a guardianship court appointment process or to using physicians or ethics committees as decision makers.

Physicians, committees, and guardians all make decisions for unrepresented patients in the US. This article considers a “tiered” approach as an alternative.

A deliberative approach to responding to needs and vulnerabilities of unrepresented patients can help make the most of having too little information.

The AMA Code of Medical Ethics discusses situations in which a surrogate is needed but not available to make health care decisions for a patient.

Legal inconsistencies and variation in end-of-life options generate disparities in care for unrepresented patients.

Ethical and practical problems with preference modeling can undermine how reliably predictors can be used in high-stakes decisions.

Decisions for patients who are unrepresented and incarcerated could be made by different classes of possible decision makers “inside” and “outside.”

When a patient is incompetent and unrepresented, alternative strategies must be implemented to document and try to rectify an error.