This scenario presents a professional challenge due to the inherent complexity of assessing the oral health needs of an aging population, which often involves multiple comorbidities, polypharmacy, and potential cognitive or functional impairments. Gerodontology requires a holistic approach that extends beyond simple dental treatment to encompass the patient’s overall well-being and quality of life. Careful judgment is required to balance the patient’s immediate dental needs with their long-term health, functional capacity, and personal preferences, all within the evolving regulatory landscape of elder care and healthcare provision. The best approach involves a comprehensive, multidisciplinary assessment that prioritizes the patient’s functional status, cognitive ability, and overall health in conjunction with their oral health needs. This includes evaluating their ability to perform oral hygiene independently, their nutritional status, and the impact of any systemic conditions or medications on their oral health. Collaboration with other healthcare professionals, such as physicians, nurses, and caregivers, is crucial to ensure a coordinated care plan that addresses all aspects of the patient’s health. This approach aligns with ethical principles of patient-centered care, beneficence, and non-maleficence, and is supported by best practice guidelines in gerodontology that emphasize a holistic and integrated model of care. An approach that focuses solely on the most pressing dental pathology without considering the patient’s functional capacity or systemic health is professionally unacceptable. This failure to integrate oral health with overall health neglects the interconnectedness of these factors in older adults and can lead to suboptimal outcomes or even iatrogenic harm if treatments are not tailored to the patient’s abilities. Another professionally unacceptable approach is to proceed with treatment based solely on the patient’s stated preferences without adequately assessing their capacity to understand the implications of their choices or the potential risks and benefits. This can violate the principle of informed consent and potentially lead to treatments that are not in the patient’s best interest, especially if cognitive impairment is present. An approach that neglects to involve other healthcare professionals when systemic conditions or medications are likely to impact oral health or treatment outcomes is also professionally unacceptable. This siloed approach fails to recognize the multidisciplinary nature of gerodontological care and can result in fragmented or ineffective treatment plans. Professionals should employ a decision-making framework that begins with a thorough patient assessment, encompassing medical history, functional status, cognitive assessment, and oral health evaluation. This should be followed by collaborative goal setting with the patient and their caregivers, considering their values and preferences. Treatment planning should then integrate oral health interventions with the patient’s overall health management, involving relevant healthcare professionals as needed. Regular reassessment and adaptation of the care plan are essential to respond to changes in the patient’s condition.

This scenario presents a professional challenge due to the inherent subjectivity in evaluating complex gerodontological cases and the need for consistent, fair application of certification standards. The examination board must balance the need for rigorous assessment with the potential for individual examiner bias or differing interpretations of the blueprint. Careful judgment is required to ensure the integrity of the certification process and maintain public trust in the specialist designation. The best professional practice involves a multi-faceted approach to blueprint weighting and scoring that prioritizes transparency, objectivity, and a robust appeals process. This includes clearly defining the weighting of each section of the examination based on its importance to gerodontological practice, establishing objective scoring rubrics for all components, and implementing a standardized review process for borderline or contested scores. Furthermore, a clearly defined retake policy that outlines the conditions under which a candidate may retake the examination, including any additional training or assessment requirements, is crucial for fairness and professional development. This approach aligns with the ethical imperative to provide a fair and equitable assessment process, ensuring that all candidates are evaluated against consistent and well-defined criteria, thereby upholding the standards of the Advanced Pan-Europe Gerodontology Specialist Certification. An incorrect approach would be to rely solely on the subjective judgment of individual examiners without a standardized scoring rubric or a mechanism for cross-validation. This introduces a high risk of bias and inconsistency, potentially leading to unfair outcomes for candidates and undermining the credibility of the certification. Such a practice fails to adhere to principles of objective assessment and could be seen as a breach of professional duty to ensure fair evaluation. Another unacceptable approach would be to have an opaque retake policy that is applied inconsistently or is overly punitive, without providing clear pathways for remediation or further learning. This can discourage candidates and create barriers to achieving specialist status, irrespective of their actual competence. It also fails to support the professional development of individuals seeking to advance their expertise in gerodontology. A further flawed approach would be to assign arbitrary weights to different sections of the examination without a clear rationale tied to the core competencies of advanced gerodontological practice. This can lead to an examination that does not accurately reflect the knowledge and skills required for specialist certification, potentially misdirecting candidate preparation and devaluing the certification itself. Professionals involved in developing and administering certification examinations should adopt a decision-making framework that emphasizes: 1) establishing clear, evidence-based criteria for weighting and scoring; 2) developing objective assessment tools and rubrics; 3) implementing rigorous quality control measures for examiner calibration and score review; and 4) ensuring transparent and fair policies for candidates, including retake procedures. This systematic approach promotes fairness, validity, and reliability in the certification process.

This scenario presents a professional challenge due to the inherent risks associated with dental materials and infection control in a specialized geriatric population. Older adults often have compromised immune systems, pre-existing medical conditions, and potential difficulties with oral hygiene, all of which increase their susceptibility to infections and adverse reactions to materials. Therefore, selecting and implementing appropriate dental materials and infection control protocols requires meticulous attention to detail, adherence to evidence-based practices, and a thorough understanding of relevant European Union (EU) regulations and guidelines pertaining to medical devices and infection prevention. Careful judgment is required to balance efficacy, patient safety, and regulatory compliance. The best professional practice involves a comprehensive risk assessment and material selection process that prioritizes patient safety and regulatory compliance. This approach entails thoroughly evaluating the biocompatibility and efficacy of dental materials, considering the specific oral health status and systemic conditions of the geriatric patient. It also mandates strict adherence to established EU directives and guidelines for medical devices, such as the Medical Device Regulation (MDR) 2017/745, which governs the safety and performance of medical devices, including dental materials. Furthermore, this approach emphasizes the implementation of robust infection control protocols, aligned with recommendations from bodies like the European Centre for Disease Prevention and Control (ECDC), to minimize the risk of healthcare-associated infections. This includes proper sterilization, disinfection, and waste management procedures, tailored to the unique needs of geriatric patients. An incorrect approach would be to select dental materials based solely on cost-effectiveness or ease of use without a thorough evaluation of their biocompatibility and potential for adverse reactions in older adults. This fails to meet the ethical obligation to prioritize patient well-being and may contravene the spirit of the MDR, which aims to ensure that medical devices are safe and perform as intended. Such a choice could lead to complications like allergic reactions, delayed healing, or increased risk of infection, all of which are particularly concerning in a geriatric population. Another professionally unacceptable approach would be to adopt a “one-size-fits-all” infection control strategy that does not account for the specific vulnerabilities of geriatric patients. This could involve neglecting enhanced disinfection protocols or failing to implement specific measures to prevent cross-contamination in the context of potentially compromised immune systems. This oversight disregards the heightened risk of infection transmission in healthcare settings and fails to uphold the principles of patient safety and infection prevention mandated by public health guidelines. A further flawed approach would be to rely on outdated or unverified information regarding dental materials and infection control practices. The field of gerodontology and the regulatory landscape are constantly evolving. Failing to stay abreast of the latest research, technological advancements, and regulatory updates can lead to the use of suboptimal materials or ineffective infection control measures, thereby compromising patient care and potentially violating regulatory requirements for the use of approved and safe medical devices. The professional reasoning process for similar situations should involve a systematic evaluation of patient-specific factors, a thorough review of available evidence regarding dental materials and infection control techniques, and a diligent assessment of compliance with all applicable EU regulations and guidelines. This includes consulting relevant professional bodies, staying updated on scientific literature, and engaging in continuous professional development to ensure the highest standards of care are maintained for geriatric patients.

This scenario is professionally challenging because it requires a gerodontology specialist to balance the immediate need for specialized knowledge with the ethical and practical considerations of professional development. The candidate’s request for a compressed, self-directed study plan, while seemingly efficient, raises concerns about the depth of understanding and the adherence to recognized standards for advanced certification. Careful judgment is required to ensure that the candidate’s preparation is robust, comprehensive, and aligns with the rigorous standards expected for advanced specialization in gerodontology. The best professional practice involves a structured, multi-faceted approach to candidate preparation that integrates formal learning with practical application and peer engagement. This approach ensures that the candidate not only acquires theoretical knowledge but also develops the critical thinking and problem-solving skills necessary for complex geriatric dental care. It emphasizes utilizing a variety of validated resources, including peer-reviewed literature, established textbooks, and accredited continuing professional development (CPD) courses specifically tailored to gerodontology. Furthermore, it encourages active participation in study groups or mentorship programs to foster discussion, clarify complex topics, and gain diverse perspectives. This comprehensive strategy aligns with the ethical imperative to provide competent and up-to-date care, as mandated by professional bodies that emphasize continuous learning and evidence-based practice. The timeline should be realistic, allowing for thorough assimilation of material and reflection, rather than prioritizing speed over depth. An approach that solely relies on a condensed, self-directed study of a limited number of recent journal articles, without incorporating foundational texts or structured learning, presents a significant ethical and professional failure. This method risks creating knowledge gaps, as it may overlook established principles and historical context crucial for a comprehensive understanding of gerodontology. It also fails to meet the implicit expectation of a broad and deep understanding required for advanced certification, potentially leading to suboptimal patient care due to an incomplete grasp of the subject matter. Another unacceptable approach involves prioritizing the acquisition of superficial knowledge through quick online summaries or non-accredited webinars. While these resources might offer a rapid overview, they often lack the depth, rigor, and evidence-based foundation necessary for specialized practice. Relying on such materials can lead to a superficial understanding and an inability to critically evaluate information or apply it effectively in clinical settings, which is a direct contravention of the duty of care owed to patients. A third flawed approach is to focus exclusively on memorizing facts and figures from a single, comprehensive textbook without engaging with current research or practical case studies. While foundational knowledge is essential, gerodontology is a dynamic field. This method neglects the importance of critical appraisal of new evidence and the application of knowledge to diverse clinical scenarios, which is a cornerstone of advanced professional practice and ethical responsibility. Professionals should employ a decision-making framework that begins with understanding the specific requirements and learning objectives of the certification. This involves identifying credible and comprehensive preparation resources that cover the breadth and depth of the subject matter. A realistic timeline should then be established, allowing for deliberate practice, critical reflection, and integration of knowledge. Seeking guidance from experienced mentors or professional bodies can further refine the preparation strategy, ensuring it is both effective and ethically sound, ultimately preparing the candidate to provide high-quality, evidence-based care.

This scenario is professionally challenging because it requires balancing a patient’s autonomy and dignity with the dentist’s professional responsibility to provide optimal care, especially when cognitive impairment may affect decision-making capacity. Navigating potential interprofessional communication barriers and ensuring continuity of care are also critical. Careful judgment is required to respect the patient’s wishes while ensuring their safety and well-being. The best approach involves a comprehensive assessment of the patient’s capacity to make decisions regarding their dental care. This includes engaging in open communication with the patient, utilizing validated tools if necessary to assess cognitive function, and involving a trusted family member or caregiver in discussions, with the patient’s explicit consent. If the patient is deemed to have capacity, their informed consent for any proposed treatment is paramount. If capacity is lacking, a surrogate decision-maker, as legally defined, should be identified and consulted. This approach aligns with the ethical principles of autonomy, beneficence, and non-maleficence, and adheres to general European guidelines on patient rights and informed consent, emphasizing the patient’s best interests while respecting their dignity and legal rights. An incorrect approach would be to proceed with treatment based solely on the family’s wishes without a formal assessment of the patient’s capacity to consent. This disregards the patient’s autonomy and could lead to ethical and legal breaches, as European regulations generally uphold the right of individuals to make decisions about their own healthcare, even if those decisions are not what their family or healthcare providers might prefer, provided they have the capacity to do so. Another incorrect approach is to defer all decision-making to the patient’s family without any attempt to assess the patient’s own understanding or wishes, or to involve them in the process to the extent of their capacity. This fails to uphold the principle of patient autonomy and can lead to a lack of patient engagement and potential dissatisfaction with care. Finally, an incorrect approach would be to unilaterally decide that the patient lacks capacity and proceed with treatment without involving a formal capacity assessment or consulting with appropriate professionals, such as a geriatrician or neurologist, if indicated. This bypasses established protocols for determining decision-making capacity and can lead to inappropriate interventions and a breakdown of trust. Professionals should employ a decision-making framework that prioritizes a thorough assessment of the patient’s capacity, followed by open communication with the patient and their chosen support network. This framework should include steps for identifying and involving appropriate interprofessional colleagues when complex medical or cognitive issues are present, ensuring that all decisions are made in the patient’s best interest and in accordance with legal and ethical standards.

Scenario Analysis: This scenario presents a professional challenge due to the inherent variability in craniofacial anatomy and the potential for subtle, yet significant, oral histological changes that may indicate early-stage pathology. A gerodontologist must integrate a deep understanding of normal aging processes in oral tissues with the ability to detect deviations that could impact patient health and treatment outcomes. The challenge lies in distinguishing between age-related changes and pathological conditions, requiring meticulous examination and diagnostic acumen. Furthermore, ethical considerations regarding patient autonomy and informed consent are paramount when discussing potential findings and treatment options. Correct Approach Analysis: The best professional practice involves a comprehensive clinical examination that meticulously assesses the patient’s craniofacial structures, including temporomandibular joint function, muscle tone, and skeletal landmarks. This is followed by a detailed intraoral examination, evaluating soft tissues for any abnormalities in color, texture, or contour, and hard tissues for signs of wear, erosion, or carious lesions. Crucially, this approach includes the systematic collection of patient history, focusing on subjective symptoms and risk factors. When any suspicious findings are noted, the next step is to correlate these clinical observations with the patient’s history and, if indicated, proceed with appropriate diagnostic aids such as advanced imaging or biopsy. This systematic, evidence-based approach ensures that all relevant anatomical, histological, and pathological aspects are considered, leading to accurate diagnosis and personalized treatment planning, aligning with the ethical duty of care and professional standards of practice in gerodontology. Incorrect Approaches Analysis: Focusing solely on the most obvious signs of decay or gross anatomical deviations without a thorough assessment of the entire craniofacial complex and detailed patient history is professionally inadequate. This approach risks overlooking subtle but critical histological changes or early-stage pathologies that may not be immediately apparent but could have significant long-term implications for the patient’s oral health and systemic well-being. Prioritizing the immediate treatment of any identified carious lesions without a comprehensive evaluation of the underlying craniofacial anatomy or potential histological indicators of broader oral health issues is also a flawed strategy. This can lead to incomplete diagnoses and treatments that do not address the root cause of the patient’s oral health status, potentially resulting in recurrent problems or the progression of undiagnosed conditions. Relying exclusively on patient self-reporting of symptoms without objective clinical and histological correlation is another professionally unsound approach. While patient history is vital, subjective complaints must be validated through rigorous examination and diagnostic procedures. This approach can lead to misdiagnosis or delayed diagnosis of significant oral pathologies. Professional Reasoning: Professionals should adopt a systematic, patient-centered approach that begins with a thorough history and a comprehensive examination of craniofacial anatomy. This should be followed by a detailed intraoral assessment, considering both hard and soft tissues. Any deviations from normal aging patterns or suspected pathological changes should be investigated further using appropriate diagnostic tools, always correlating findings with the patient’s history and overall health status. Ethical considerations, including informed consent and patient autonomy, must guide all diagnostic and treatment decisions. This integrated approach ensures the highest standard of care, promoting accurate diagnosis, effective treatment, and improved patient outcomes.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the clinician’s professional judgment regarding their capacity to make informed decisions. The dentist must navigate the ethical principles of autonomy, beneficence, and non-maleficence, while also adhering to professional standards of care and legal requirements concerning patient consent and capacity assessment. The potential for a patient’s cognitive decline to impact their ability to understand treatment options and consequences necessitates a careful and sensitive approach. Correct Approach Analysis: The best professional practice involves a multi-faceted approach that prioritizes patient well-being and respects their autonomy to the greatest extent possible. This begins with a thorough and documented assessment of the patient’s capacity to understand the proposed treatment, its risks, benefits, and alternatives. This assessment should be conducted in a manner that is sensitive to potential cognitive impairments, perhaps involving simpler language, visual aids, and repeated explanations. If capacity is deemed present, the patient’s informed consent should be obtained, and their wishes respected. If capacity is questionable or absent, the dentist must then engage with the patient’s legally authorized representative or next of kin to discuss treatment options and obtain consent, always acting in the patient’s best interests and seeking the least restrictive intervention. This approach upholds the ethical duty to respect patient autonomy while ensuring beneficence and avoiding harm. Incorrect Approaches Analysis: One incorrect approach would be to proceed with the elective treatment based solely on the patient’s stated desire, without a formal capacity assessment, especially given the noted cognitive concerns. This fails to uphold the dentist’s duty of care and the principle of beneficence, as it risks performing a procedure on a patient who may not fully comprehend its implications or necessity, potentially leading to harm or dissatisfaction. It also bypasses the ethical and legal requirement for informed consent. Another incorrect approach would be to immediately dismiss the patient’s wishes and proceed directly to involving a representative without first attempting to assess the patient’s capacity themselves. This prematurely overrides the patient’s autonomy and can be perceived as disrespectful, potentially damaging the patient-dentist relationship. While involving a representative is necessary if capacity is lacking, the initial step should be a professional assessment by the dentist. A further incorrect approach would be to postpone all treatment indefinitely due to concerns about capacity, without exploring alternative solutions or seeking further assessment. This could lead to the patient’s oral health deteriorating unnecessarily, failing the dentist’s duty of beneficence and potentially causing greater harm in the long run. It also fails to explore options for managing treatment with a potentially fluctuating or partially impaired capacity. Professional Reasoning: Professionals facing such dilemmas should employ a structured decision-making process. First, gather all relevant information about the patient’s condition and wishes. Second, assess the patient’s capacity to understand the specific decision at hand, documenting the process and findings thoroughly. Third, if capacity is present, obtain informed consent and proceed accordingly. Fourth, if capacity is questionable or absent, engage with appropriate individuals (family, guardians) and explore options for treatment that align with the patient’s best interests, always prioritizing their well-being and dignity. Ethical guidelines and professional standards should serve as the primary compass throughout this process.

Scenario Analysis: This scenario presents a professional challenge rooted in the ethical obligation to uphold the integrity of specialist certifications while also acknowledging the evolving nature of professional development and the potential for individuals to acquire advanced skills through non-traditional pathways. The core tension lies in balancing the established criteria for certification with the recognition of demonstrable expertise gained outside of formal, accredited programs. Careful judgment is required to ensure that the certification process remains robust and credible, preventing dilution of its value, while also remaining inclusive and fair to practitioners who may have achieved equivalent or superior competencies through alternative means. Correct Approach Analysis: The best professional practice involves a thorough, evidence-based assessment of the applicant’s existing qualifications and experience against the specific learning outcomes and competency standards defined for the Advanced Pan-Europe Gerodontology Specialist Certification. This approach prioritizes objective evaluation of demonstrated skills and knowledge, irrespective of the formal route of acquisition. It aligns with the principle of meritocracy in professional recognition, ensuring that only those who demonstrably meet the advanced standards are certified, thereby safeguarding the public interest and the reputation of the certification body. This methodical review process upholds the purpose of the certification, which is to identify and recognize individuals possessing a high level of specialized expertise in gerodontology, ensuring they are equipped to provide advanced care to the aging population. Incorrect Approaches Analysis: One incorrect approach involves outright rejection of the application solely because the applicant has not completed a formally recognized pan-European gerodontology specialist training program. This fails to acknowledge that advanced competencies can be acquired through a variety of means, including extensive clinical experience, specialized postgraduate courses, research, and contributions to the field, which may not be formally accredited by a pan-European body. This rigid adherence to a single pathway undermines the purpose of the certification, which is to identify advanced expertise, not merely adherence to a specific educational itinerary. Another incorrect approach is to grant certification based on a superficial review of the applicant’s general dental qualifications and a brief statement of interest in gerodontology. This approach neglects the rigorous standards required for advanced specialization. It risks certifying individuals who lack the depth of knowledge and practical skills necessary for advanced gerodontic practice, potentially compromising patient care and devaluing the certification itself. This bypasses the essential eligibility criteria designed to ensure a high standard of specialized competence. A further incorrect approach is to require the applicant to undertake the entire formal Advanced Pan-Europe Gerodontology Specialist Certification program from scratch, despite evidence of significant prior experience and advanced training. While some bridging modules might be appropriate, a complete repetition of a program already mastered through equivalent experience is inefficient and fails to recognize prior learning. This can be seen as an unnecessary barrier, potentially discouraging highly competent practitioners from seeking formal recognition and thereby limiting the pool of recognized specialists. Professional Reasoning: Professionals faced with such situations should employ a structured decision-making process. This begins with a clear understanding of the stated purpose and eligibility criteria for the certification. Next, they must gather comprehensive evidence of the applicant’s qualifications, experience, and achievements. This evidence should then be objectively assessed against the defined competency standards. Where gaps exist, a process for addressing them, such as targeted assessments or supplementary training, should be considered. The ultimate decision should be based on a holistic evaluation of whether the applicant demonstrably possesses the advanced knowledge, skills, and ethical understanding required for specialist practice, irrespective of the specific educational pathway taken. Transparency and fairness are paramount throughout this process.

This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the clinician’s professional judgment regarding their capacity and the best course of action. The ethical imperative is to balance patient autonomy with the duty of care, particularly when cognitive impairment may affect decision-making. Careful judgment is required to ensure the patient’s well-being while respecting their dignity and rights. The correct approach involves a thorough, multi-faceted assessment of the patient’s cognitive status and decision-making capacity, involving relevant professionals and potentially family members or advocates, while prioritizing the patient’s expressed wishes as much as possible within the bounds of safety and ethical practice. This aligns with the principles of informed consent, beneficence, and non-maleficence, as well as the European Federation of Gerodontology (EFG) guidelines which emphasize patient-centered care and the importance of assessing capacity in a nuanced manner. It acknowledges that capacity can fluctuate and requires a comprehensive evaluation beyond a simple yes/no answer. An approach that unilaterally overrides the patient’s wishes based on a single observation or a limited assessment fails to uphold the principle of autonomy and may constitute a breach of ethical guidelines. It risks paternalism and can erode patient trust. Another incorrect approach is to proceed with treatment without adequately exploring the patient’s understanding or the reasons behind their refusal, especially if there are indications of potential cognitive impairment. This neglects the duty to ensure informed consent and could lead to inappropriate or unwanted interventions. Finally, abandoning the patient or deferring all decision-making to family without proper capacity assessment and patient involvement is ethically unsound. It fails to acknowledge the patient’s right to participate in their care to the extent of their capacity and can lead to decisions that do not truly reflect the patient’s values or best interests. Professionals should employ a structured decision-making process that begins with a comprehensive assessment of the patient’s capacity, including their ability to understand information, appreciate the consequences of their decisions, and communicate their choice. This should involve open communication with the patient, seeking clarification, and exploring their rationale. If capacity is questionable, involving a multidisciplinary team, including specialists in geriatric medicine or psychiatry, is crucial. Family or designated representatives should be involved as support and to provide context, but the patient’s voice, to the extent of their capacity, must remain central. Documentation of all assessments, discussions, and decisions is paramount.

The scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the clinician’s assessment of their best interests, particularly when the patient’s capacity to make informed decisions is in question. This requires a delicate balance between respecting patient autonomy and fulfilling the duty of care, necessitating careful judgment and adherence to ethical and legal frameworks governing patient decision-making. The approach that represents best professional practice involves a thorough, documented assessment of the patient’s capacity to understand the proposed treatment, its risks and benefits, and alternatives, and to communicate their decision. If capacity is found, their informed refusal must be respected, even if it conflicts with the clinician’s recommendation. This aligns with the fundamental ethical principle of patient autonomy and is supported by European legal frameworks that emphasize informed consent and the right of competent individuals to refuse treatment. The General Medical Council (GMC) guidelines in the UK, for instance, stress that a competent patient has the right to refuse any medical treatment, even if that decision seems unwise to others. An incorrect approach involves overriding a patient’s refusal of treatment solely based on the clinician’s belief that it is in the patient’s best interest, without a formal, documented assessment of capacity. This fails to uphold the principle of autonomy and could constitute a breach of professional duty and potentially legal battery. Another incorrect approach is to proceed with treatment without obtaining informed consent, even if the patient appears to understand the situation. This disregards the requirement for explicit agreement to a proposed course of action and violates the patient’s right to self-determination. A further incorrect approach is to assume a lack of capacity based on age or perceived frailty, without undertaking a proper assessment. This is discriminatory and undermines the presumption of capacity that all adults possess unless proven otherwise. Professionals should employ a decision-making framework that prioritizes a structured assessment of capacity. This involves gathering information about the patient’s understanding, appreciation of the situation, reasoning abilities, and ability to communicate a choice. If capacity is present, their decision, even if it leads to a less favourable outcome from the clinician’s perspective, must be respected. If capacity is lacking, the professional must act in the patient’s best interests, which may involve seeking a decision from a legally authorized representative or, in some jurisdictions, seeking court intervention, always with thorough documentation.