AMA Journal of Ethics^®

Patients leaving against medical advice draw attention to intersections of tort law, federal and state regulations, and clinical ethics.

Shared decision making is practically difficult to implement in mental health practice but remains an ethical ideal for motivating therapeutic capacity.

Dr Laura Guidry-Grimes helps us consider whether and which decisions can be shared with people experiencing mental illnesses.

Shared decision making honors patient autonomy, particularly for preference-sensitive care decisions and even when patients have impaired decision-making capacity.

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.

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.