Scenario Analysis: This scenario is professionally challenging because it requires balancing the immediate need for improved patient care with the rigorous demands of evidence-based practice and regulatory compliance. Advanced practice clinicians in cardio-renal medicine are expected to be leaders in quality improvement and research translation, but they must navigate ethical considerations, resource limitations, and the imperative to ensure patient safety and data integrity. The pressure to implement changes quickly must be tempered by a systematic, evidence-driven approach that aligns with established guidelines and institutional policies. Correct Approach Analysis: The best professional practice involves a systematic, multi-faceted approach that prioritizes evidence gathering, stakeholder engagement, and a phased implementation strategy. This begins with a thorough literature review and analysis of existing local data to identify the most effective and evidence-based interventions for the identified gap in post-discharge cardio-renal patient management. Crucially, it involves forming a multidisciplinary team, including physicians, nurses, pharmacists, and patient representatives, to co-design and pilot the intervention. This collaborative approach ensures buy-in, addresses diverse perspectives, and allows for iterative refinement based on real-world feedback. The subsequent plan for broader rollout would include robust data collection mechanisms to monitor outcomes, patient safety, and adherence to the new protocol, with a clear commitment to ongoing evaluation and adaptation. This aligns with the principles of continuous quality improvement and research translation, ensuring that changes are not only innovative but also safe, effective, and sustainable, adhering to best practices in healthcare delivery and research ethics. Incorrect Approaches Analysis: One incorrect approach involves immediately implementing a novel protocol based solely on anecdotal evidence or a single promising research study without local validation or broader stakeholder consensus. This bypasses essential steps in quality improvement and research translation, potentially leading to unintended consequences, patient harm, or poor adoption rates. It fails to adequately consider the specific patient population, existing workflows, or resource availability within the institution, and it neglects the ethical imperative to rigorously evaluate interventions before widespread application. Another unacceptable approach is to delay implementation indefinitely due to a perceived lack of resources or the complexity of the research translation process. While resource constraints are real, a complete halt to progress ignores the ongoing need for quality improvement and the potential for innovative solutions to be developed and piloted within existing frameworks. This approach fails to demonstrate proactive leadership in patient care and misses opportunities to contribute to the evidence base for cardio-renal medicine. A further flawed approach is to focus solely on the research aspect, publishing findings without a clear plan for translating them into tangible improvements in patient care within the clinical setting. While research is vital, its ultimate value in advanced practice lies in its application to improve patient outcomes. This approach neglects the practical challenges and ethical responsibilities of implementing evidence-based changes at the point of care. Professional Reasoning: Professionals should adopt a structured decision-making process that integrates evidence-based practice, quality improvement methodologies, and ethical considerations. This involves: 1) Identifying a clinical problem or opportunity for improvement. 2) Conducting a comprehensive literature search and critically appraising relevant research. 3) Analyzing local data and patient outcomes. 4) Engaging stakeholders (patients, colleagues, leadership) to gather input and build consensus. 5) Developing a feasible, evidence-based intervention plan, often starting with a pilot study. 6) Implementing the intervention with robust monitoring and evaluation mechanisms. 7) Disseminating findings and adapting the intervention as needed. This iterative process ensures that advancements in cardio-renal medicine are effectively translated into improved patient care in a safe, ethical, and sustainable manner.

Scenario Analysis: This scenario presents a challenge in interpreting and applying the eligibility criteria for an advanced practice examination within a specialized medical field. Professionals must navigate potentially ambiguous wording and ensure their qualifications align precisely with the examination’s stated purpose and requirements, avoiding both over-qualification and under-qualification. The risk lies in misinterpreting the scope of “advanced practice” or the specific nature of the Nordic cardio-renal context, potentially leading to wasted application efforts or, more critically, an applicant being deemed ineligible after significant preparation. Correct Approach Analysis: The best approach involves a meticulous review of the examination’s official documentation, specifically focusing on the stated purpose and detailed eligibility criteria. This includes understanding the intended level of advanced practice (e.g., independent practice, specialized diagnostic interpretation, advanced therapeutic management) and how the applicant’s current role and experience within Nordic cardio-renal medicine directly map to these requirements. Confirmation of eligibility should be sought directly from the examination board if any ambiguity persists after thorough self-assessment. This ensures adherence to the precise framework established by the examination setters, preventing misapplication of personal experience to criteria that may have specific nuances within the Nordic context. Incorrect Approaches Analysis: One incorrect approach is to assume that extensive experience in a related but not identical specialty (e.g., general cardiology or nephrology without a specific cardio-renal focus) automatically satisfies the advanced practice requirement. This fails to acknowledge the specialized nature of the Elite Nordic Cardio-Renal Medicine examination, which likely targets a unique intersection of these disciplines. Another incorrect approach is to focus solely on the duration of clinical practice without considering the specific advanced competencies and responsibilities outlined in the eligibility criteria. The examination is for “Advanced Practice,” implying a level of skill and autonomy beyond standard practice, which a simple time-based metric might not capture. Finally, relying on informal advice from colleagues or outdated information without verifying against the current official guidelines is professionally unsound. This can lead to decisions based on incomplete or inaccurate understanding of the examination’s current requirements. Professional Reasoning: Professionals should approach eligibility for specialized examinations with a principle of strict adherence to stated requirements. The decision-making process should begin with a comprehensive understanding of the examination’s stated purpose and target audience. This is followed by a detailed, point-by-point comparison of one’s own qualifications, experience, and scope of practice against each eligibility criterion. When in doubt, direct communication with the examination administrators or board is paramount to ensure accurate interpretation and avoid potential disqualification. This systematic and verification-based approach minimizes risk and ensures that applications are submitted with a high degree of confidence in meeting the stated prerequisites.

This scenario is professionally challenging because it requires the advanced practice clinician to navigate a complex ethical and regulatory landscape concerning patient data privacy and the appropriate use of technology in healthcare, specifically within the context of a specialized medical field like Nordic Cardio-Renal Medicine. The rapid advancement of digital health tools, while beneficial, introduces new risks and necessitates a thorough understanding of established guidelines. Careful judgment is required to balance the potential benefits of data sharing for research and improved patient care against the fundamental right to privacy and the legal obligations to protect sensitive health information. The correct approach involves prioritizing patient consent and adhering strictly to data protection regulations. This means obtaining explicit, informed consent from patients before sharing any identifiable or potentially identifiable health data, even for research purposes. The consent process must clearly outline what data will be shared, with whom, for what purpose, and for how long, ensuring the patient understands their rights and the implications. This aligns with the core ethical principles of autonomy and beneficence, as well as regulatory frameworks like the General Data Protection Regulation (GDPR) if applicable to the Nordic context, which mandates a lawful basis for data processing, often requiring explicit consent for sensitive health data. An incorrect approach would be to proceed with data sharing based on a general assumption of research benefit without explicit patient consent. This violates the principle of patient autonomy and breaches data protection laws by processing sensitive personal data without a valid legal basis. Another incorrect approach is to anonymize data without a robust and verifiable anonymization process. Incomplete or flawed anonymization can still lead to re-identification, exposing patients to privacy risks and contravening regulatory requirements for data protection. Finally, relying solely on institutional review board (IRB) approval without individual patient consent for data that could potentially identify them is also an unacceptable approach. While IRB approval is crucial for research ethics, it does not supersede the individual’s right to control their personal health information, especially when that information is not fully anonymized. Professionals should employ a decision-making framework that begins with identifying the core ethical and legal obligations. This involves understanding the specific data protection laws and professional guidelines relevant to their practice. Next, they should assess the nature of the data in question and the potential risks to patient privacy. The paramount consideration should always be patient autonomy and the requirement for informed consent. When in doubt, seeking guidance from legal counsel or ethics committees is a crucial step in ensuring compliance and upholding professional standards.

This scenario is professionally challenging due to the potential for delayed diagnosis and suboptimal treatment stemming from an unorganized and potentially biased approach to diagnostic imaging. The patient presents with complex, overlapping cardio-renal symptoms, necessitating a systematic and evidence-based selection of imaging modalities. Careful judgment is required to balance diagnostic yield, patient safety, cost-effectiveness, and adherence to established clinical guidelines. The best professional practice involves a structured diagnostic reasoning workflow that prioritizes imaging based on the most likely underlying pathology and the specific clinical question being asked. This approach begins with a thorough clinical assessment, including detailed history, physical examination, and initial laboratory investigations. Based on this comprehensive evaluation, the clinician then selects the most appropriate imaging modality that offers the highest diagnostic accuracy for the suspected condition, while minimizing radiation exposure and contrast agent risks. This is often guided by established clinical pathways and imaging protocols, ensuring a logical progression from less invasive to more invasive or complex investigations if necessary. This systematic approach aligns with ethical principles of beneficence and non-maleficence, ensuring the patient receives appropriate care efficiently and safely, and adheres to professional standards of practice that emphasize evidence-based decision-making. An incorrect approach would be to order a broad, non-specific array of imaging studies without a clear diagnostic hypothesis. This is professionally unacceptable as it can lead to unnecessary radiation exposure, increased healthcare costs, potential for incidental findings that cause patient anxiety and further unnecessary investigations, and delays in reaching a definitive diagnosis. It also demonstrates a failure to apply critical diagnostic reasoning, potentially leading to a misallocation of resources and suboptimal patient management. Another unacceptable approach is to select imaging based solely on availability or personal familiarity with a particular modality, rather than its suitability for the specific clinical presentation. This can result in missing critical diagnostic information or obtaining misleading results, violating the principle of providing the best possible care. It also fails to acknowledge the evolving landscape of diagnostic imaging and the importance of choosing the most evidence-based tool for the task. Furthermore, ordering imaging without a clear, specific clinical question to be answered by the study is also professionally unsound. This leads to a lack of focus in interpretation and can result in a report that is not clinically useful, potentially delaying appropriate management. It represents a failure to engage in the critical step of formulating a precise diagnostic query that guides the imaging selection and interpretation process. Professionals should employ a decision-making framework that begins with a comprehensive clinical assessment, followed by the formulation of differential diagnoses. This leads to the identification of specific diagnostic questions that need to be answered. Imaging selection should then be guided by evidence-based guidelines and the principle of selecting the modality that best answers the clinical question with the lowest risk and cost. Interpretation should be performed by qualified professionals who are aware of the clinical context and the specific questions posed. Regular review of diagnostic pathways and adherence to quality improvement initiatives in imaging are also crucial.

Scenario Analysis: This scenario is professionally challenging due to the complexity of managing a patient with multiple co-morbidities (hypertension, chronic kidney disease, and heart failure) who presents with acute decompensation. The challenge lies in balancing immediate symptom relief with long-term evidence-based management strategies, ensuring patient safety, and adhering to established clinical guidelines. The need for rapid assessment and intervention, while simultaneously considering the patient’s chronic conditions and potential drug interactions, requires a nuanced and evidence-informed approach. Correct Approach Analysis: The best professional practice involves a comprehensive assessment to identify the primary driver of the acute decompensation, followed by the initiation of guideline-directed medical therapy tailored to the patient’s specific cardiovascular and renal status. This includes optimizing diuretics for fluid overload, titrating renin-angiotensin-aldosterone system inhibitors (if tolerated and appropriate for the stage of CKD), and considering beta-blockers for heart failure management, all while closely monitoring renal function and electrolyte balance. This approach is correct because it directly addresses the acute presentation while integrating evidence-based strategies for chronic disease management, aligning with best practices for cardio-renal medicine and prioritizing patient outcomes through a holistic, evidence-informed lens. Incorrect Approaches Analysis: Initiating aggressive diuresis without a thorough assessment of the patient’s current volume status and renal function risks precipitating acute kidney injury or severe electrolyte disturbances, which is contrary to the principle of patient safety and evidence-based management. This approach fails to consider the delicate balance required in patients with compromised renal function. Focusing solely on symptomatic relief of dyspnea with high-dose diuretics without addressing the underlying cardiac dysfunction or optimizing chronic medications neglects the evidence-based management of heart failure and chronic kidney disease, potentially leading to recurrent decompensations and poorer long-term prognosis. This approach is reactive rather than proactive and evidence-driven. Discontinuing all existing cardio-renal medications due to the acute presentation without a clear indication or a plan for reintroduction or adjustment is a failure to adhere to evidence-based guidelines for chronic disease management. This can lead to uncontrolled chronic conditions and worsen the patient’s overall health status. Professional Reasoning: Professionals should approach such complex cases by first performing a rapid yet thorough assessment to pinpoint the acute issue. This should be followed by a systematic review of the patient’s chronic conditions and current medications. The decision-making process should then involve consulting current, evidence-based clinical guidelines for heart failure, hypertension, and chronic kidney disease, prioritizing interventions that address both the acute symptoms and the underlying chronic pathologies safely and effectively. Continuous monitoring and adjustment of therapy based on the patient’s response and evolving clinical picture are paramount.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a clinician’s desire to provide immediate, potentially life-saving treatment and the regulatory requirement for informed consent, especially when dealing with a vulnerable patient population. The advanced practice clinician must navigate the ethical imperative to act in the patient’s best interest while respecting their autonomy and adhering to established legal and professional guidelines. The urgency of the clinical situation, coupled with the patient’s diminished capacity, necessitates a careful and well-documented decision-making process. Correct Approach Analysis: The best professional practice involves seeking to obtain consent from the nearest appropriate relative or legal guardian. This approach respects the patient’s right to autonomy, even when their capacity is compromised, by involving those legally empowered to make decisions on their behalf. It aligns with ethical principles of beneficence and non-maleficence by ensuring that treatment decisions are made with the patient’s best interests at heart, as interpreted by their designated representative. This is also supported by general principles of medical ethics and patient rights legislation that prioritize involving family or legal guardians when a patient lacks capacity. Incorrect Approaches Analysis: Attempting to proceed with treatment without any form of consent, even in an emergency, is ethically and legally problematic. While emergency exceptions exist, they are typically narrowly defined and require immediate, life-threatening circumstances where no alternative exists and no surrogate decision-maker can be reached. In this scenario, time permits for attempting to contact a relative. Proceeding without consent risks violating the patient’s autonomy and could lead to legal repercussions. Delaying treatment indefinitely while waiting for absolute certainty of the patient’s capacity or the arrival of a specific family member could be detrimental to the patient’s health. While consent is crucial, the principle of beneficence dictates that necessary medical intervention should not be unreasonably withheld when a patient’s well-being is at stake, provided appropriate steps are taken to secure consent or act under established emergency protocols. Seeking consent from a distant acquaintance or a colleague not designated as a legal guardian or next of kin is inappropriate. While these individuals might have the patient’s best interests at heart, they lack the legal authority to provide consent for medical treatment. This approach bypasses the established legal framework for surrogate decision-making and could invalidate the consent obtained. Professional Reasoning: Professionals should employ a structured decision-making process that prioritizes patient autonomy and legal compliance. When a patient’s capacity is in question, the first step is to assess the degree of impairment. If capacity is diminished, the next step is to identify and contact the nearest appropriate relative or legal guardian to obtain informed consent. If no such person can be identified or contacted within a reasonable timeframe, and the situation is emergent, the clinician must document the rationale for proceeding with treatment based on the patient’s best interests and the lack of available surrogate decision-makers, adhering to institutional policies and relevant emergency provisions.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the need for continuous professional development and maintaining competence with the practical realities of an advanced practitioner’s demanding workload. The examination’s blueprint weighting, scoring, and retake policies are designed to ensure a high standard of knowledge and skill, but their application can create stress and uncertainty for individuals. Careful judgment is required to interpret these policies fairly and to support practitioners appropriately. Correct Approach Analysis: The best professional approach involves a thorough understanding of the examination blueprint’s weighting for each domain, recognizing how this directly influences the scoring and the overall pass mark. It also necessitates a clear grasp of the retake policy, including any limitations on the number of attempts or the timeframe for re-examination. This understanding allows for targeted preparation and realistic goal setting. Adhering to the official examination guidelines, which outline these policies, is paramount. This approach ensures that preparation is focused on areas of higher weighting and that the practitioner is aware of the consequences and procedures related to failing to meet the required standard, thereby promoting a fair and transparent assessment process. Incorrect Approaches Analysis: One incorrect approach is to focus solely on perceived personal strengths or areas of interest, neglecting the blueprint’s weighting. This can lead to inadequate preparation in critical, high-weighted domains, increasing the likelihood of failing to achieve the required score, even if other areas are mastered. Another incorrect approach is to disregard the retake policy, assuming multiple attempts will be readily available without understanding any associated restrictions or timelines. This can lead to disappointment and a prolonged period of uncertainty if a retake is not as straightforward as anticipated. Finally, relying on informal or anecdotal information about scoring and retake policies, rather than consulting the official examination documentation, is a significant failure. This can lead to misinterpretations, unrealistic expectations, and ultimately, a lack of preparedness for the actual assessment requirements. Professional Reasoning: Professionals facing this situation should adopt a systematic approach. First, they must actively seek out and thoroughly review the official examination blueprint and associated policies. This document serves as the definitive guide to weighting, scoring, and retake procedures. Second, they should use this information to create a structured and prioritized study plan, allocating time and resources in proportion to the blueprint’s weighting. Third, they must understand the implications of the retake policy for their career progression and personal development timeline. Finally, if any aspect of the policies remains unclear, they should seek clarification directly from the examination board or relevant regulatory body.

The evaluation methodology shows that candidates for the Elite Nordic Cardio-Renal Medicine Advanced Practice Examination are assessed on their preparedness, including their understanding of effective study strategies and resource utilization. This scenario is professionally challenging because it requires the candidate to balance comprehensive knowledge acquisition with efficient time management, a critical skill for advanced practitioners who often manage demanding workloads. Misjudging preparation resources or timelines can lead to inadequate knowledge, increased stress, and ultimately, a failure to meet the high standards of the examination. Careful judgment is required to select a preparation strategy that is both thorough and realistic. The best approach involves a structured, multi-modal preparation plan that prioritizes core curriculum areas identified by the examination syllabus, integrates diverse learning materials, and incorporates regular self-assessment. This strategy is correct because it aligns with best practices in adult learning and professional development. It ensures that the candidate systematically covers all essential topics, reinforces learning through varied methods (e.g., reading, case studies, practice questions), and allows for early identification of knowledge gaps. This methodical approach maximizes the likelihood of comprehensive understanding and retention, directly addressing the examination’s requirement for advanced knowledge and application. It also implicitly acknowledges the need for a realistic timeline, allowing for sufficient depth in each area without superficial coverage. An approach that relies solely on reviewing past examination papers without a foundational understanding of the core curriculum is professionally unacceptable. This fails to build a robust knowledge base and risks overlooking critical concepts not explicitly tested in previous papers. It neglects the fundamental principle of comprehensive learning required for advanced practice. Another professionally unacceptable approach is to focus exclusively on a single type of resource, such as only reading textbooks, while ignoring other valuable materials like clinical guidelines or peer-reviewed articles. This limits exposure to different perspectives and application contexts, potentially leading to a narrow understanding of complex cardio-renal medicine. It also fails to leverage the breadth of resources typically recommended for advanced professional examinations. Finally, an approach that involves cramming material in the weeks immediately preceding the examination is also professionally unacceptable. This method is known to be ineffective for long-term knowledge retention and deep understanding, which are essential for advanced practice. It creates undue stress and is unlikely to equip the candidate with the confidence and comprehensive knowledge needed to perform well under examination conditions. The professional reasoning framework for similar situations should involve: 1) Thoroughly reviewing the official examination syllabus and any recommended reading lists to understand the scope and depth of knowledge required. 2) Identifying a variety of high-quality preparation resources, including textbooks, current clinical guidelines, relevant research articles, and reputable online learning platforms. 3) Developing a realistic study schedule that allocates sufficient time for each topic, incorporates regular review sessions, and includes practice questions or mock examinations. 4) Regularly assessing progress and adjusting the study plan as needed to address any identified weaknesses.

This scenario is professionally challenging because it requires the advanced practice clinician to balance immediate patient needs with the complex ethical and regulatory considerations surrounding the use of novel, off-label treatments. The pressure to provide a potentially life-saving intervention must be weighed against the established protocols for patient safety, informed consent, and the responsible application of medical knowledge. Careful judgment is required to navigate the grey areas of experimental therapies while adhering to professional standards and patient well-being. The correct approach involves a thorough, documented discussion with the patient and their legal guardian regarding the experimental nature of the proposed treatment, its potential benefits and risks, and the availability of alternative, established therapies. This discussion must be meticulously documented in the patient’s medical record, including the patient’s understanding and consent, or the guardian’s consent on behalf of the patient. This aligns with fundamental ethical principles of autonomy and beneficence, as well as regulatory requirements for informed consent for investigational treatments, even when administered in a clinical setting outside of a formal trial. The emphasis on documentation ensures transparency and accountability. An incorrect approach would be to administer the off-label treatment without a comprehensive discussion and explicit consent from the patient or their guardian. This fails to uphold the principle of patient autonomy and violates the ethical and regulatory imperative for informed consent, particularly when dealing with unproven therapies. The lack of documentation further exacerbates the professional and legal risks. Another incorrect approach would be to proceed with the treatment based solely on the clinician’s professional judgment without engaging the patient or guardian in the decision-making process. While clinical expertise is vital, it does not supersede the patient’s right to be informed and to participate in decisions about their own care, especially when novel or experimental interventions are considered. This approach disregards the ethical duty of shared decision-making. A further incorrect approach would be to delay treatment indefinitely due to the experimental nature of the therapy, without exploring all avenues for obtaining appropriate consent or seeking ethical review. While caution is warranted, an outright refusal to consider a potentially beneficial, albeit experimental, treatment without due diligence and patient involvement can be detrimental to patient care and may not align with the clinician’s duty to explore all reasonable options. The professional reasoning framework for such situations should involve a systematic evaluation of the patient’s condition, the available evidence for the proposed off-label treatment, and the patient’s values and preferences. This should be followed by a transparent and comprehensive discussion with the patient and/or their guardian, ensuring they understand the risks, benefits, and alternatives. Documentation of this process is paramount. If ethical or regulatory uncertainties persist, consultation with an ethics committee or relevant regulatory bodies should be considered.

Scenario Analysis: This scenario presents a professional challenge rooted in the tension between a patient’s expressed wishes and the clinician’s assessment of their best interests, complicated by the patient’s cognitive state. The advanced practice clinician must navigate the ethical principles of autonomy, beneficence, and non-maleficence, while adhering to legal frameworks governing informed consent and patient capacity. The health system’s role in supporting these decisions, through clear protocols and interdisciplinary collaboration, is also paramount. The core difficulty lies in determining if the patient’s refusal of a life-sustaining treatment is a valid exercise of autonomy or a manifestation of impaired decision-making capacity, requiring a delicate balance of respect for the individual and the duty to prevent harm. Correct Approach Analysis: The best professional approach involves a systematic and documented assessment of the patient’s capacity to make decisions regarding their treatment. This entails evaluating their ability to understand the information provided, appreciate the consequences of their decision, reason through the options, and communicate their choice. If capacity is found to be impaired, the next step is to involve the patient’s designated healthcare proxy or next of kin, following established legal and ethical guidelines for substitute decision-making. This approach upholds the principle of beneficence by ensuring the patient receives appropriate care while respecting their previously expressed wishes or best interests as determined by a legally recognized surrogate. It aligns with the ethical imperative to act in the patient’s best interest when their autonomy is compromised and adheres to legal requirements for informed consent and decision-making capacity. Incorrect Approaches Analysis: One incorrect approach would be to immediately override the patient’s refusal and proceed with the treatment based solely on the clinician’s judgment of what is medically necessary. This fails to respect the patient’s autonomy, even if their capacity is questionable, and bypasses the crucial step of assessing decision-making capacity. It also neglects the legal and ethical requirement to involve surrogates when capacity is lacking. Another incorrect approach would be to accept the patient’s refusal at face value without any attempt to assess their capacity or explore the underlying reasons for their decision. This could lead to significant harm if the patient is unable to understand the gravity of their condition or the benefits of the proposed treatment due to cognitive impairment. It fails the principle of beneficence and potentially non-maleficence. A third incorrect approach would be to proceed with treatment without adequately informing the patient or their surrogate about the risks, benefits, and alternatives, even if capacity is deemed present. This violates the core principle of informed consent, which requires a thorough understanding of the proposed intervention. Professional Reasoning: Professionals should employ a structured decision-making process when faced with a patient refusing potentially life-sustaining treatment. This process begins with a comprehensive assessment of the patient’s understanding of their condition, the proposed treatment, its benefits, risks, and alternatives. If there is any doubt about the patient’s capacity, a formal capacity assessment should be conducted, involving relevant professionals if necessary. If capacity is found to be lacking, the next step is to identify and engage the appropriate substitute decision-maker, adhering to legal and ethical guidelines. Throughout this process, clear, empathetic communication with the patient and their family is essential, documenting all assessments, discussions, and decisions meticulously. The health system should have clear policies and procedures to support clinicians in these complex situations, including access to ethics consultations and legal advice.