The guidelines for patients’ eligibility for bariatric surgery have not changed since 1991, although recent data suggest there may be indications for broadening application of the surgery.
Advance directives, substituted judgment, and the best-interest standard all have limitations that constrain their usefulness in making medical decisions for patients who cannot choose for themselves.
Writing a case study of a psychiatric patient may change the patient-physician dynamic even if the patient consents to be written about. And when the patient is a minor and consent must involve her parents, the process becomes even more complicated.