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.
The ideal grading system would measure student achievement of established learning objectives and, at the same time, encourage the development of desirable professional behaviors.
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.