AMA Journal of Ethics

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

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

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

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

When patients are unable to express their wishes and do not have surrogates or advance directives, which and whose values should inform decision making for them? We discuss ethical complexities of caring for unrepresented patients.

End-stage heart failure patients can experience depression along with their chronic illness. Multidisciplinary responses are critical.

Patients have a right to decline or withdraw LVADs. Informed consent and shared decision making is not easy, however, with treatments that are high risk, high reward.

When patients cannot give informed consent or refusal for antipsychotic medication, physicians must meet specific criteria to justify temporarily withholding a diagnosis.

Perhaps machine learning systems trained on patients’ electronic health records and social media footprints could be used as decision aids when patients lack capacity or face overwhelming decisions.

A patient’s refusal of tracheostomy during an anticipated difficult intubation prompts critical questions about how to best express respect for a pediatric patient’s autonomy and whether and when deviation from standard of care is clinically and ethically appropriate.