The scenario presents a challenge in understanding the nuanced eligibility criteria for advanced practice examinations, specifically the Comprehensive Pan-Asia Surgical Critical Care Advanced Practice Examination. Professionals must navigate the stated purpose of the examination and its intended audience to determine who is best suited to undertake it, ensuring that the examination serves its intended function of advancing specialized critical care surgical practice across the Pan-Asian region. Misinterpreting eligibility can lead to individuals undertaking examinations for which they are not adequately prepared, potentially undermining the credibility of the certification and the development of advanced practitioners. The best approach involves a thorough review of the examination’s stated purpose and the defined eligibility requirements, focusing on the advanced practice nature of surgical critical care and the Pan-Asian scope. This means identifying candidates who possess the requisite clinical experience, advanced training, and a commitment to practicing within the specified region. The examination is designed to recognize and credential individuals who have demonstrated a high level of competence and expertise in surgical critical care, contributing to improved patient outcomes and the advancement of the specialty across Asia. Adhering strictly to these defined parameters ensures that the examination effectively identifies qualified advanced practitioners and upholds the standards of the certification. An incorrect approach would be to assume that any surgical professional with critical care experience is eligible, without considering the “advanced practice” designation or the Pan-Asian focus. This overlooks the specific intent of the examination to certify a higher level of specialized expertise and regional applicability. Another incorrect approach would be to prioritize general surgical experience over specific surgical critical care experience, or to disregard the geographical scope of the examination. This would dilute the examination’s purpose of fostering specialized critical care surgical expertise within the Pan-Asian context. Finally, an approach that focuses solely on the desire to gain international recognition without meeting the foundational eligibility criteria would be misguided, as it prioritizes personal ambition over the established standards and objectives of the examination. Professionals should approach eligibility assessment by first understanding the examination’s stated objectives and then meticulously cross-referencing these with an individual’s qualifications and experience. This involves a critical evaluation of whether the candidate’s background aligns with the advanced practice competencies and the geographical intent of the certification. A structured decision-making process would involve: 1) identifying the examination’s core purpose and target audience; 2) detailing the explicit eligibility criteria; 3) assessing the candidate’s profile against each criterion; and 4) making a determination based on a comprehensive match, rather than assumptions or partial alignment.

Scenario Analysis: This scenario presents a professional challenge due to the inherent risks associated with surgical instrumentation and energy devices in a critical care setting. Ensuring patient safety, maintaining instrument integrity, and adhering to established protocols for device use and maintenance are paramount. The critical care environment often involves complex cases and time-sensitive procedures, demanding meticulous attention to detail and a thorough understanding of operative principles and safety guidelines. Failure to adhere to these principles can lead to adverse patient outcomes, including surgical site infections, thermal injury, or device malfunction. Correct Approach Analysis: The best professional practice involves a comprehensive pre-operative assessment of all surgical instruments and energy devices. This includes a thorough visual inspection for any signs of damage, wear, or contamination, and verification of proper functioning according to manufacturer guidelines and institutional protocols. For energy devices, this means confirming that all components are intact, that safety features are operational, and that the device has undergone scheduled maintenance and testing. This approach directly aligns with the fundamental ethical obligation to provide safe and effective patient care, as well as regulatory requirements that mandate the use of properly maintained and functional medical equipment. Adherence to these standards minimizes the risk of iatrogenic harm and ensures the integrity of the surgical procedure. Incorrect Approaches Analysis: One incorrect approach involves relying solely on the assumption that instruments and devices are in good working order simply because they were used in a previous procedure. This overlooks the possibility of subtle damage or wear that may have occurred, or the potential for contamination that was not adequately addressed during reprocessing. This approach fails to meet the standard of due diligence required for patient safety and contravenes institutional policies and best practices for instrument and device management. Another incorrect approach is to proceed with a procedure without confirming the functionality of energy devices, particularly if there is any doubt about their performance. This demonstrates a disregard for established safety protocols and manufacturer instructions, which are designed to prevent adverse events such as unintended burns or device failure during critical moments of surgery. This oversight can lead to significant patient harm and constitutes a breach of professional responsibility. A further incorrect approach is to delegate the responsibility for checking instrument and device readiness to junior staff without adequate supervision or verification. While teamwork is essential, ultimate accountability for patient safety rests with the senior clinician. This approach risks a breakdown in the chain of responsibility and could result in critical safety checks being missed or performed inadequately, jeopardizing patient well-being. Professional Reasoning: Professionals should adopt a systematic and proactive approach to operative principles and energy device safety. This involves establishing a pre-operative checklist that includes a detailed inspection of all instruments and devices. For energy devices, this checklist should specifically address functionality, safety features, and maintenance records. A culture of safety should be fostered, where all team members feel empowered to raise concerns about equipment integrity. Regular training on the proper use, maintenance, and troubleshooting of surgical instruments and energy devices is crucial. In situations of doubt, it is always best to err on the side of caution, seek clarification, or obtain alternative equipment rather than proceeding with potentially compromised tools.

Scenario Analysis: This scenario presents a professional challenge due to the inherent tension between immediate patient care needs and the established protocols for advanced practice professional development and supervision. The critical care environment demands swift action, but advanced practice professionals are expected to operate within defined scopes of practice and under appropriate oversight, especially when encountering novel or complex situations. The need to balance autonomy with accountability, and to ensure patient safety while fostering professional growth, requires careful judgment. Correct Approach Analysis: The best professional approach involves immediately consulting with the supervising physician to discuss the observed anomaly and the proposed intervention. This aligns with the principles of collaborative practice and physician oversight, which are fundamental to advanced practice roles in surgical critical care. Regulatory frameworks and professional guidelines in Pan-Asia surgical critical care settings emphasize that advanced practice professionals should seek guidance from their supervising physician when encountering situations that fall outside their routine experience or established protocols, or when considering interventions that may have significant implications. This ensures that patient care decisions are made with the benefit of the physician’s expertise and within the established legal and ethical boundaries of practice, thereby safeguarding patient well-being and maintaining professional accountability. Incorrect Approaches Analysis: Proceeding with the intervention without consulting the supervising physician, despite the novelty of the finding, represents a significant ethical and regulatory failure. It bypasses the established chain of command and the requirement for physician oversight in complex or unusual clinical scenarios, potentially jeopardizing patient safety and exceeding the advanced practice professional’s scope of practice. Administering a standard treatment protocol for a suspected but unconfirmed condition, without further investigation or consultation, is also professionally unacceptable. This approach risks misdiagnosis and inappropriate treatment, which can lead to adverse patient outcomes and violates the ethical duty to provide evidence-based and individualized care. Documenting the intervention as if it were routine, without disclosing the consultation or the novel nature of the finding to the supervising physician, constitutes a breach of professional integrity and transparency. This misrepresentation can hinder accurate medical record-keeping, impede future clinical decision-making, and erode trust within the healthcare team. Professional Reasoning: Professionals in surgical critical care should adopt a decision-making framework that prioritizes patient safety and adheres to regulatory and ethical standards. This involves: 1) Recognizing and acknowledging the limits of one’s expertise or the novelty of a clinical situation. 2) Actively seeking consultation with the appropriate supervising physician or senior clinician when uncertainty exists or when considering interventions outside of established protocols. 3) Ensuring clear and accurate documentation of all clinical assessments, decisions, and interventions, including any consultations sought. 4) Maintaining open and transparent communication with the entire healthcare team.

Scenario Analysis: This scenario is professionally challenging due to the inherent uncertainty in critical care trauma, the rapid deterioration of a patient, and the need for immediate, life-saving interventions. Balancing the urgency of resuscitation with the requirement for informed consent, especially when a patient is incapacitated, presents a significant ethical and legal tightrope. The advanced practice clinician must navigate potential conflicts between immediate medical necessity and established patient rights, all within a high-pressure environment. Correct Approach Analysis: The best professional practice involves initiating life-saving resuscitation measures based on the principle of implied consent in emergency situations, while simultaneously making diligent and documented efforts to obtain explicit consent from a surrogate decision-maker as soon as reasonably possible. This approach prioritizes the patient’s immediate survival, which is the paramount ethical and legal obligation in a life-threatening emergency. Regulatory frameworks and ethical guidelines universally support the concept that a patient who is unable to consent due to their condition is presumed to consent to necessary emergency treatment to preserve life or limb. The prompt documentation of the patient’s condition, the rationale for treatment, and the subsequent efforts to contact and obtain consent from a surrogate are crucial for legal and ethical defensibility. Incorrect Approaches Analysis: Initiating resuscitation without any attempt to contact a surrogate decision-maker, even after the patient has stabilized slightly, fails to respect the patient’s autonomy and the rights of their legal representatives to be involved in decision-making once the immediate life-threatening crisis has passed. This approach risks legal challenge and ethical criticism for not seeking to involve the patient’s family or designated proxy in ongoing care decisions. Delaying essential resuscitation measures until explicit consent is obtained from a surrogate decision-maker, when the patient is clearly incapacitated and facing imminent death or severe disability, is a direct violation of the duty to preserve life. This approach prioritizes procedural consent over the patient’s immediate well-being and is ethically indefensible and legally perilous. Proceeding with resuscitation and then informing the surrogate after all critical interventions are completed, without any prior attempt to contact them or explain the situation, demonstrates a lack of transparency and respect for the surrogate’s role. While the immediate resuscitation may have been justified, the subsequent communication failure undermines trust and the collaborative decision-making process that should ideally follow. Professional Reasoning: Professionals should employ a tiered approach to consent in emergency trauma. First, assess the patient’s capacity to consent. If incapacitated, the immediate priority is life-saving intervention under implied consent. Concurrently, initiate efforts to identify and contact a surrogate decision-maker. Once the patient is stabilized and the surrogate is available, engage in shared decision-making regarding further treatment, ensuring all actions are thoroughly documented.

Governance review demonstrates a critical need to refine the management of post-operative complications in complex surgical cases within the Pan-Asia region. This scenario is professionally challenging due to the inherent variability in patient presentations, the potential for rapid deterioration, and the ethical imperative to provide timely and effective care while adhering to established best practices and regional guidelines. Careful judgment is required to balance immediate patient needs with the need for systematic, evidence-based management and appropriate escalation. The best approach involves immediate, structured assessment and intervention based on established critical care protocols, followed by prompt, multidisciplinary consultation. This approach is correct because it prioritizes patient safety by initiating life-sustaining measures and diagnostic workups without delay. It aligns with the principles of critical care medicine, emphasizing early recognition and management of deteriorating patients. Furthermore, it reflects ethical obligations to provide competent care and the professional responsibility to seek expert advice when faced with complex or uncertain situations, ensuring that the patient receives the most appropriate and timely interventions from a coordinated team. An approach that delays definitive management or consultation in favor of less urgent investigations or solely relying on the primary surgical team’s initial assessment is professionally unacceptable. This failure to act decisively and seek timely specialist input can lead to delayed diagnosis and treatment of critical complications, potentially resulting in adverse patient outcomes and violating the ethical duty of care. It also risks contravening regional guidelines that advocate for prompt escalation of care in critical surgical patients. Another professionally unacceptable approach is to manage the complication in isolation without involving relevant specialists, such as intensivists or other surgical subspecialties. This siloed approach ignores the complex interplay of physiological systems in critically ill patients and the potential for complications to have systemic effects. It represents a failure to leverage the collective expertise necessary for optimal patient management and may violate professional standards that mandate multidisciplinary care for complex cases. Finally, an approach that focuses on documenting the event without initiating immediate corrective actions or seeking appropriate consultation is ethically and professionally deficient. While documentation is crucial, it must follow, not precede or replace, timely and effective clinical intervention. This failure to act promptly in the face of a deteriorating patient constitutes a dereliction of duty and a breach of the fundamental principles of patient care. Professionals should employ a decision-making framework that begins with a rapid assessment of the patient’s hemodynamic and respiratory status. This should be followed by the initiation of supportive measures and a systematic diagnostic workup. Concurrently, or immediately thereafter, consultation with critical care specialists and relevant surgical subspecialties should be sought. This iterative process of assessment, intervention, and consultation ensures that patient care is dynamic and responsive to their evolving condition, guided by evidence-based practice and ethical considerations.

Scenario Analysis: This scenario presents a common yet complex challenge in surgical critical care: balancing the immediate need for life-saving intervention with the ethical and legal imperative of informed consent. The professional challenge lies in accurately assessing the patient’s capacity to consent when they are critically ill and potentially disoriented, and in navigating the legal framework for surrogate decision-making. Failure to obtain appropriate consent or to follow established protocols for incapacitated patients can lead to legal repercussions, ethical breaches, and erosion of patient trust. Careful judgment is required to determine the patient’s current capacity and to involve the correct individuals in the decision-making process. Correct Approach Analysis: The best professional practice involves a multi-faceted approach to assessing capacity and obtaining consent. This begins with a direct assessment of the patient’s ability to understand their condition, the proposed treatment, its risks and benefits, and alternatives, and to communicate their decision. If the patient is deemed to lack capacity, the next step is to identify and consult with the legally authorized surrogate decision-maker, following established hospital policy and relevant legal statutes. This ensures that decisions are made in accordance with the patient’s known wishes or best interests, upholding their autonomy and dignity. This approach is correct because it prioritizes patient autonomy while acknowledging the realities of critical illness and the legal framework for decision-making when capacity is compromised. It aligns with ethical principles of beneficence, non-maleficence, and respect for persons, and adheres to regulatory requirements for informed consent and surrogate decision-making. Incorrect Approaches Analysis: One incorrect approach involves proceeding with surgery based solely on the physician’s judgment of medical necessity without a formal assessment of the patient’s capacity or consultation with a surrogate decision-maker, even if the patient appears disoriented. This fails to respect the patient’s right to self-determination and bypasses crucial legal and ethical safeguards. It can lead to allegations of battery or medical malpractice. Another incorrect approach is to delay necessary surgical intervention indefinitely while attempting to locate a distant family member who may not be the legally authorized surrogate, thereby jeopardizing the patient’s life. While seeking family input is often valuable, the legal framework for surrogate decision-making must be followed, and life-saving interventions should not be unduly postponed when a clear pathway for consent exists or when the patient’s condition is imminently life-threatening and no surrogate can be immediately identified. This approach can be ethically problematic due to the principle of beneficence and may violate institutional policies on emergency care. A third incorrect approach is to rely on the consent of a nurse or junior resident who is not the legally authorized surrogate decision-maker, even if they have a close relationship with the patient. While healthcare professionals are vital members of the care team, they do not possess the legal authority to provide consent for a patient unless they are also the designated surrogate. This constitutes a failure to obtain valid consent and can have significant legal and ethical ramifications. Professional Reasoning: Professionals should employ a structured decision-making process that begins with a thorough assessment of the patient’s capacity to consent. This involves evaluating their understanding, appreciation, reasoning, and ability to communicate a choice. If capacity is present, informed consent should be obtained directly from the patient. If capacity is lacking, the next step is to identify the legally authorized surrogate decision-maker according to institutional policy and applicable laws. This process ensures that patient rights are protected, medical interventions are ethically sound, and legal compliance is maintained, particularly in time-sensitive critical care situations.

This scenario presents a professional challenge due to the inherent complexities and potential for unforeseen complications in advanced surgical critical care. The need for structured operative planning with robust risk mitigation is paramount to ensure patient safety, optimize outcomes, and uphold professional standards. The core of the challenge lies in balancing the necessity of decisive action with thorough preparation, anticipating potential adverse events, and having pre-defined strategies to address them. This requires a deep understanding of the patient’s condition, the surgical procedure, and the available resources, all within a framework of ethical and regulatory compliance. The best approach involves a comprehensive, multidisciplinary pre-operative assessment and planning session. This includes detailed review of the patient’s medical history, imaging, and laboratory data, followed by a structured discussion among the surgical team, anaesthetists, critical care physicians, and nursing staff. During this session, potential risks are systematically identified, their likelihood and impact assessed, and specific contingency plans are developed. This might involve identifying alternative surgical approaches, securing necessary equipment and blood products in advance, and establishing clear communication protocols for intra-operative events. This approach is correct because it aligns with the principles of patient-centered care, promotes shared decision-making, and adheres to best practices in surgical safety, such as those emphasized by international surgical quality initiatives and professional medical associations that advocate for proactive risk management and thorough preparation to minimize preventable harm. An approach that relies solely on the lead surgeon’s experience without formal team consultation and documented risk assessment is professionally unacceptable. This failure to engage the multidisciplinary team can lead to missed critical information, lack of preparedness for specific complications, and potential communication breakdowns during surgery. Ethically, it falls short of the duty to provide the highest standard of care and can be seen as a breach of professional responsibility to ensure all available expertise is leveraged. Another unacceptable approach is to proceed with a vague understanding of potential risks, assuming that problems can be addressed as they arise. This reactive strategy is inherently dangerous in complex surgical critical care. It neglects the fundamental principle of proactive risk mitigation and can lead to delayed or suboptimal responses to critical events, increasing the likelihood of adverse patient outcomes. This approach fails to meet the professional expectation of thorough preparation and demonstrates a disregard for established patient safety protocols. Finally, an approach that prioritizes speed of initiation over comprehensive planning, perhaps due to perceived time constraints or pressure, is also professionally flawed. While timely intervention is crucial, it must not come at the expense of adequate preparation. Rushing the planning phase can result in overlooking critical details, inadequate resource allocation, and a higher probability of intra-operative complications that could have been anticipated and mitigated. This demonstrates a lack of adherence to the rigorous standards expected in advanced surgical critical care. Professionals should adopt a decision-making process that prioritizes a structured, team-based approach to operative planning. This involves establishing clear protocols for pre-operative assessments, encouraging open communication and critical appraisal of potential risks among all team members, and documenting contingency plans. Regular simulation exercises and debriefings can further enhance preparedness and team cohesion. The focus should always be on anticipating challenges and developing robust strategies to overcome them, thereby ensuring the best possible care for the patient.

This scenario presents a professional challenge due to the inherent tension between maintaining the integrity of the examination process and providing equitable opportunities for candidates. The examination board must balance the need for standardized assessment with considerations for individual circumstances that might impact a candidate’s performance or ability to participate. Careful judgment is required to ensure fairness, transparency, and adherence to established policies. The best professional approach involves a thorough review of the examination board’s established blueprint, scoring methodology, and retake policies, coupled with a clear, documented communication process. This approach prioritizes adherence to the pre-defined governance framework, ensuring consistency and fairness for all candidates. By consulting the official documentation, the board can objectively determine the candidate’s eligibility for a retake, the specific conditions under which it would be granted (e.g., if the initial failure was marginal and attributable to documented extenuating circumstances), and the implications for their overall examination status. This aligns with principles of good governance and regulatory compliance, ensuring that decisions are based on established rules rather than ad hoc considerations. An incorrect approach would be to grant a retake solely based on the candidate’s expressed desire or perceived potential, without reference to the official retake policy. This bypasses the established governance framework, potentially creating a precedent for preferential treatment and undermining the credibility of the examination. It fails to uphold the principle of equal application of rules, which is a cornerstone of fair assessment. Another incorrect approach would be to dismiss the candidate’s request outright without any consideration or review of the examination board’s policies. While adherence to policy is crucial, a complete dismissal without a review process can be perceived as inflexible and lacking in empathy, potentially leading to reputational damage for the examination board. It fails to acknowledge that policies often have provisions for exceptional circumstances, and a review process is designed to identify such instances. Finally, an incorrect approach would be to modify the scoring criteria or blueprint for this specific candidate to allow them to pass. This is a severe breach of examination integrity. It directly contravenes the principle of standardized assessment, as it alters the objective measure of competence. Such an action would invalidate the examination results for all other candidates and severely damage the reputation and trustworthiness of the examination board. Professionals should employ a decision-making framework that begins with a clear understanding of the governing policies and procedures. When faced with a candidate’s request that deviates from the norm, the first step is to consult the relevant documentation (blueprint, scoring, retake policies). If the situation falls within an exception clause or requires interpretation, a formal review process should be initiated, involving relevant stakeholders and ensuring that any decision is documented and justifiable against the established framework. Transparency in communication with the candidate throughout this process is also paramount.

Scenario Analysis: This scenario presents a common challenge for advanced practice professionals preparing for high-stakes examinations like the Comprehensive Pan-Asia Surgical Critical Care Advanced Practice Examination. The challenge lies in balancing the need for comprehensive knowledge acquisition with the practical constraints of time and available resources. Professionals must make informed decisions about how to allocate their study time and which resources to prioritize to maximize their chances of success while adhering to ethical standards of professional development. The pressure to perform well, coupled with the vastness of the subject matter, necessitates a strategic and evidence-based approach to preparation. Correct Approach Analysis: The best approach involves a structured, multi-modal study plan that integrates official examination blueprints, peer-reviewed literature, and simulated practice questions. This method is correct because it directly aligns with the stated objectives of the examination, ensuring that preparation is focused on the most relevant content areas. Utilizing official blueprints provides a regulatory-aligned roadmap, while engaging with peer-reviewed literature ensures exposure to current best practices and evidence-based guidelines, which are often implicitly or explicitly tested. Simulated practice questions, particularly those developed by reputable professional bodies or aligned with examination formats, offer invaluable insights into question style, difficulty, and the application of knowledge in clinical scenarios. This comprehensive strategy not only covers the breadth of the syllabus but also hones critical thinking and application skills, which are essential for advanced practice. Incorrect Approaches Analysis: Relying solely on a single textbook, even if comprehensive, is an insufficient approach. This fails to account for the dynamic nature of medical knowledge and the potential for the textbook to become outdated. It also neglects the importance of understanding the specific emphasis and format of the examination, which may not be fully captured by a single publication. Furthermore, it limits exposure to diverse perspectives and the latest research findings, potentially leading to gaps in knowledge. Focusing exclusively on memorizing facts and figures without engaging in application-based learning or practice questions is another inadequate approach. While factual recall is necessary, advanced practice examinations typically assess the ability to apply knowledge to complex clinical situations, interpret data, and make sound clinical judgments. This method neglects the development of these crucial higher-order cognitive skills. Prioritizing informal study groups and anecdotal advice over structured resources is professionally unsound. While peer discussion can be beneficial, it lacks the rigor and systematic coverage provided by official materials and evidence-based literature. Anecdotal advice may be biased, inaccurate, or not relevant to the specific examination content, leading to misdirected study efforts and potential ethical breaches if it leads to the dissemination of incorrect information. Professional Reasoning: Professionals should approach examination preparation with a strategic mindset, akin to developing a clinical management plan. This involves: 1. Assessment: Thoroughly reviewing the examination syllabus and any official guidance documents to understand the scope and weighting of topics. 2. Planning: Developing a realistic study timeline, breaking down the syllabus into manageable sections, and allocating time for each. 3. Intervention: Selecting a diverse range of high-quality resources, including official blueprints, current peer-reviewed literature, and reputable practice question banks. 4. Evaluation: Regularly assessing progress through self-testing and practice examinations, identifying areas of weakness, and adjusting the study plan accordingly. 5. Consultation: Engaging with mentors or colleagues who have successfully navigated similar examinations for guidance, but always prioritizing evidence-based resources.

This scenario presents a professional challenge due to the inherent conflict between patient autonomy, the duty of care, and the practical limitations of resource allocation within a critical care setting. The attending physician must navigate these complexities while upholding ethical principles and regulatory compliance. Careful judgment is required to balance the immediate needs of the patient with the broader responsibilities of the healthcare team and the institution. The best approach involves a comprehensive assessment of the patient’s current clinical status, prognosis, and the availability of appropriate resources, followed by a transparent and empathetic discussion with the patient and their family. This approach prioritizes shared decision-making, ensuring that the patient’s values and preferences are central to the care plan, while also acknowledging the clinical realities and the need for equitable resource distribution. This aligns with ethical principles of beneficence, non-maleficence, and respect for autonomy, and is supported by guidelines that emphasize patient-centered care and open communication in critical situations. An approach that solely focuses on the patient’s immediate desire for continued aggressive treatment without considering the broader clinical context or resource implications is ethically problematic. It risks prolonging suffering without a realistic prospect of meaningful recovery and may divert resources from other patients who could benefit more significantly. This fails to uphold the principle of justice in resource allocation. Another unacceptable approach is to unilaterally withdraw life-sustaining treatment based on a physician’s personal judgment of futility without engaging the patient or family in a discussion. This disregards the patient’s right to autonomy and can lead to profound distress and mistrust. It also fails to adhere to established protocols for end-of-life care discussions. Finally, an approach that prioritizes institutional cost-saving measures over the patient’s clinical needs and expressed wishes is ethically indefensible. Healthcare decisions must be driven by patient well-being and clinical evidence, not solely by financial considerations. This violates the physician’s fiduciary duty to the patient. Professionals should employ a structured decision-making process that begins with a thorough clinical evaluation, followed by an open and honest dialogue with the patient and their family. This dialogue should explore goals of care, potential benefits and burdens of treatment, and alternative options. Consultation with ethics committees or palliative care specialists can provide valuable support and guidance in complex cases. The ultimate decision should be a collaborative one, respecting the patient’s values and the clinical realities.