Interventions’ influences on decision making situate clinician performance evaluations in key ways.

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

Using the patient’s worldview to challenge his or her decision and establish a treatment plan—implying the view is shared by the physician when it is not—could be seen as manipulative and deceptive.

The U. S. health care system encourages patients to take more responsibility for their own treatment decisions and expects their doctors to cooperate in that effort. But the guidelines for exercising that responsibility remain very murky indeed.