Scenario Analysis: This scenario presents a common yet challenging situation in healthcare where a recognized gap in patient outcomes for a specific demographic (women with complex cardiac conditions) requires systematic improvement. The challenge lies in translating observed disparities into actionable, evidence-based interventions that are both effective and ethically sound, while navigating the complexities of data collection, analysis, and implementation within a resource-constrained environment. Professional judgment is required to identify the most robust and ethical pathway to address the quality gap. Correct Approach Analysis: The most effective approach involves a systematic, data-driven quality improvement initiative. This begins with a thorough review of existing patient data to precisely define the scope and nature of the quality gap, identifying specific areas of concern such as diagnostic delays, suboptimal treatment adherence, or post-discharge complications. This data then informs the development of targeted interventions, which could include enhanced patient education, standardized care pathways, or improved interdisciplinary communication. Crucially, this approach emphasizes continuous monitoring and evaluation of the implemented interventions using the same data metrics, allowing for iterative refinement and ensuring sustained improvement in patient safety and outcomes. This aligns with the ethical imperative to provide the highest standard of care and the professional responsibility to actively seek and implement evidence-based improvements. Regulatory frameworks often mandate quality assurance and patient safety programs, making this a compliant and best-practice strategy. Incorrect Approaches Analysis: One incorrect approach would be to rely solely on anecdotal evidence or the opinions of a few senior clinicians to guide interventions. This fails to provide a robust, objective understanding of the problem, potentially leading to the implementation of ineffective or even harmful interventions. It bypasses the critical step of data validation, which is essential for identifying true quality gaps and measuring the impact of changes. This approach also risks overlooking systemic issues that may not be apparent through individual experiences, and it lacks the accountability inherent in data-driven decision-making. Another unacceptable approach would be to implement a broad, un-targeted intervention without first analyzing the specific data points contributing to the observed disparity. For example, simply increasing the frequency of patient follow-up appointments without understanding *why* current follow-up is insufficient or what specific issues arise during those appointments would be inefficient and unlikely to yield significant improvements. This approach wastes resources and fails to address the root causes of the quality gap, potentially leading to patient frustration and continued suboptimal outcomes. It also demonstrates a lack of systematic problem-solving, a core tenet of quality improvement. A further flawed approach would be to implement changes based on a single, isolated incident or a small number of cases without broader data analysis. While individual cases can highlight potential issues, they are not representative of systemic problems. This approach can lead to overreactions or misallocation of resources, focusing on rare events rather than common, impactful issues. It lacks the statistical rigor necessary to ensure that interventions are addressing the most prevalent and significant contributors to the quality gap, and it fails to establish a baseline for measuring improvement. Professional Reasoning: Professionals facing such a scenario should employ a structured problem-solving framework. First, clearly define the problem using objective data. Second, identify the root causes of the problem through detailed analysis. Third, develop evidence-based, targeted interventions. Fourth, implement these interventions systematically. Fifth, continuously monitor and evaluate the impact of the interventions using the same data metrics. Finally, adapt and refine the interventions based on the evaluation results. This iterative, data-driven cycle ensures that efforts are focused, effective, and contribute to sustained improvements in patient care and safety.

Scenario Analysis: This scenario presents a professional challenge due to the inherent conflict between a patient’s expressed wishes and the clinician’s ethical and professional obligation to provide evidence-based care, especially when those wishes may stem from misinformation or cultural beliefs that could negatively impact health outcomes. Navigating this requires sensitivity, strong communication skills, and a deep understanding of patient autonomy versus beneficence, all within the framework of global women’s health best practices. The urgency of the situation, given the potential for serious complications, adds another layer of complexity. Correct Approach Analysis: The best professional approach involves a comprehensive, culturally sensitive discussion with the patient and her family, aiming to understand the root of her refusal and provide accurate, evidence-based information about the risks and benefits of the recommended treatment. This approach prioritizes shared decision-making, respecting the patient’s autonomy while fulfilling the clinician’s duty of beneficence. It involves active listening, empathy, and a commitment to addressing the patient’s concerns and fears directly. By seeking to build trust and understanding, the clinician can work collaboratively towards a treatment plan that is both medically sound and acceptable to the patient, potentially involving alternative or modified interventions if appropriate and safe. This aligns with ethical principles of informed consent and patient-centered care, which are paramount in global women’s health where diverse cultural contexts influence healthcare decisions. Incorrect Approaches Analysis: One incorrect approach involves immediately overriding the patient’s wishes and proceeding with the intervention based solely on the clinician’s medical judgment. This fails to respect patient autonomy and informed consent, potentially leading to a breakdown in the patient-physician relationship and a refusal of all future care. It ignores the ethical imperative to understand and address the patient’s underlying reasons for refusal. Another incorrect approach is to simply accept the patient’s refusal without further exploration or attempting to provide education. This neglects the clinician’s duty of beneficence, as it allows a potentially harmful situation to persist without intervention, even when effective treatments are available. It fails to advocate for the patient’s well-being by not actively engaging in overcoming barriers to care. A third incorrect approach is to apply undue pressure or coercion to force the patient into accepting the treatment. This is ethically unacceptable and violates the principles of informed consent and patient autonomy. It can create a climate of fear and distrust, damaging the therapeutic relationship and potentially leading to adverse psychological outcomes for the patient. Professional Reasoning: Professionals facing such dilemmas should employ a framework that begins with a thorough assessment of the patient’s understanding and concerns. This is followed by clear, empathetic communication of medical information, tailored to the patient’s cultural context and literacy level. The next step involves exploring the patient’s values and preferences, and collaboratively developing a treatment plan that balances medical necessity with patient autonomy. If consensus cannot be reached, seeking ethical consultation or involving a multidisciplinary team can provide additional support and guidance. The ultimate goal is to achieve the best possible health outcome for the patient while upholding her dignity and rights.

This scenario presents a professionally challenging situation due to the inherent conflict between a patient’s expressed wishes and the perceived best interests of their unborn child, particularly when those wishes involve potentially life-altering medical decisions during pregnancy. Navigating this requires a delicate balance of respecting patient autonomy, upholding the physician’s duty of care, and adhering to ethical and legal frameworks governing reproductive healthcare and fetal well-being. Careful judgment is required to ensure that decisions are made in a manner that is both legally sound and ethically defensible, prioritizing the patient’s informed consent while also considering the potential implications for the fetus. The approach that represents best professional practice involves a comprehensive, multidisciplinary discussion with the patient, ensuring full understanding of all available options, risks, and benefits, and documenting her informed consent meticulously. This includes exploring the patient’s values, beliefs, and the rationale behind her decisions, while also providing clear, unbiased information about the medical implications for both herself and the fetus. Engaging specialists in maternal-fetal medicine, neonatology, and ethics, as well as social work and palliative care if indicated, ensures that all aspects of the patient’s and fetus’s needs are considered. This approach aligns with the fundamental ethical principles of beneficence, non-maleficence, and respect for autonomy, and is supported by legal precedents emphasizing informed consent as paramount in medical decision-making, even in complex obstetric cases. An approach that involves unilaterally overriding the patient’s stated wishes based on a physician’s personal or institutional interpretation of the fetus’s best interests, without robust legal or ethical justification and without exhausting all avenues for patient understanding and agreement, is professionally unacceptable. This constitutes a violation of patient autonomy and can lead to legal repercussions for battery or medical negligence. Similarly, an approach that focuses solely on the potential negative outcomes for the fetus without adequately engaging the patient in shared decision-making or exploring her capacity and understanding of her choices fails to uphold the ethical obligation to treat the pregnant patient as an individual with rights and agency. Furthermore, an approach that delays or obstructs access to necessary medical information or consultations for the patient, thereby hindering her ability to make a truly informed decision, is also ethically and professionally unsound. Professionals should employ a decision-making framework that begins with a thorough assessment of the patient’s capacity to make decisions. This involves ensuring she has received all relevant information in an understandable format, has had her questions answered, and is free from coercion. If capacity is in question, appropriate legal and ethical protocols for surrogate decision-making must be followed. The framework should then prioritize open, empathetic communication, fostering a trusting relationship with the patient. A multidisciplinary team approach is crucial for complex cases, allowing for diverse perspectives and comprehensive care planning. Throughout the process, meticulous documentation of all discussions, assessments, and decisions is essential for accountability and legal protection.

This scenario is professionally challenging because it requires balancing diagnostic accuracy with resource stewardship, particularly in a global health context where resources may be limited. The physician must navigate potential biases, patient factors, and the evolving landscape of diagnostic technologies to arrive at the most appropriate imaging strategy. Careful judgment is required to avoid unnecessary investigations that could burden patients and healthcare systems, while also ensuring critical diagnoses are not missed. The best professional practice involves a systematic, stepwise approach to diagnostic reasoning and imaging selection. This begins with a thorough clinical assessment, including detailed history and physical examination, to formulate a differential diagnosis. Based on this differential, the physician then selects the most appropriate initial imaging modality that offers the highest diagnostic yield for the most likely or most critical conditions, considering factors like availability, cost, and patient safety. Subsequent imaging decisions are then guided by the findings of the initial investigation and the patient’s clinical evolution. This approach aligns with ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm), as well as principles of responsible resource allocation, often implicitly or explicitly guided by professional guidelines and institutional policies that promote evidence-based and cost-effective care. An approach that prioritizes advanced imaging modalities without a clear clinical indication or prior less invasive investigations is professionally unacceptable. This can lead to unnecessary radiation exposure, increased costs, and potential for incidental findings that cause patient anxiety and further investigations. It fails to adhere to the principle of proportionality, where the invasiveness and cost of an investigation should be commensurate with the suspected condition and its potential impact. Another professionally unacceptable approach is to rely solely on readily available imaging without considering its diagnostic limitations for the specific clinical question. This can result in delayed or missed diagnoses, leading to suboptimal patient outcomes and potentially violating the duty of care. It demonstrates a failure to critically evaluate the appropriateness of the chosen diagnostic tool in relation to the clinical context. Finally, an approach that neglects to integrate imaging findings with the overall clinical picture and patient presentation is also professionally unsound. Imaging is a tool to aid diagnosis, not a replacement for clinical reasoning. Failing to synthesize all available information can lead to misinterpretation of results and inappropriate management decisions. Professionals should employ a decision-making framework that emphasizes a strong clinical foundation, a tiered approach to diagnostic testing, and continuous reassessment of the diagnostic strategy based on evolving clinical information and imaging results. This involves a commitment to lifelong learning regarding diagnostic technologies and their appropriate application.

The efficiency study reveals a critical challenge in managing women’s health across acute, chronic, and preventive care settings. This scenario is professionally challenging because it requires a nuanced understanding of evidence-based practices while navigating diverse patient needs, resource limitations, and the potential for fragmented care delivery. Careful judgment is required to ensure that interventions are not only clinically effective but also ethically sound and aligned with best practices in global women’s health. The best approach involves a comprehensive, integrated strategy that prioritizes evidence-based guidelines for all three care domains. This includes proactive screening and early intervention for chronic conditions, timely and effective management of acute presentations, and robust preventive care programs informed by the latest research. Such an approach ensures that patients receive continuous, high-quality care that addresses their immediate needs while also mitigating future health risks. This aligns with the ethical imperative to provide holistic care and the professional responsibility to stay abreast of and implement evidence-based recommendations to optimize patient outcomes. An approach that solely focuses on acute care without adequately addressing chronic disease management or preventive measures is ethically deficient. It fails to meet the standard of comprehensive care and can lead to poorer long-term health outcomes for women, potentially exacerbating existing health disparities. Similarly, an approach that emphasizes preventive care but neglects the effective management of acute conditions or the ongoing support for chronic illnesses leaves significant gaps in patient care, violating the principle of beneficence. Finally, an approach that relies on outdated or non-evidence-based practices, even if seemingly efficient, is professionally unacceptable. It risks providing suboptimal or even harmful care, undermining patient trust and failing to uphold the commitment to evidence-based medicine. Professionals should employ a decision-making framework that begins with a thorough assessment of the evidence for interventions across acute, chronic, and preventive care. This should be followed by an evaluation of patient-specific factors, including their individual health status, preferences, and socioeconomic context. Integrating these considerations with available resources and ethical principles will guide the selection and implementation of the most appropriate and effective care strategies.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the need for fair and consistent evaluation of fellowship candidates with the imperative to maintain the integrity and perceived fairness of the examination process. Decisions regarding blueprint weighting, scoring, and retake policies directly impact candidate opportunities and the overall credibility of the fellowship program. Mismanagement can lead to legal challenges, reputational damage, and a decline in the quality of future applicants. Careful judgment is required to ensure these policies are transparent, equitable, and aligned with the program’s educational objectives and the standards of the Critical Global Women’s Health Internal Medicine Fellowship. Correct Approach Analysis: The best professional practice involves a transparent and documented process for establishing and communicating blueprint weighting, scoring, and retake policies. This approach ensures that all candidates are aware of the evaluation criteria from the outset, fostering a sense of fairness and predictability. Specifically, the fellowship program should have a clearly defined committee responsible for developing these policies, with input from faculty and potentially external experts. The rationale behind the weighting of different content areas on the exam should be explicitly linked to the core competencies and learning objectives of the fellowship. Scoring should be standardized and validated to ensure objectivity, and retake policies should be clearly articulated, outlining the conditions under which a retake is permissible and the process involved. This approach is ethically sound as it upholds principles of fairness and transparency, and it aligns with best practices in medical education assessment, which emphasize validity, reliability, and fairness. Incorrect Approaches Analysis: One incorrect approach involves unilaterally altering the blueprint weighting and scoring criteria for individual candidates based on perceived performance during the fellowship without prior notification or established policy. This is ethically problematic as it violates the principle of fairness by applying ex post facto changes to evaluation standards. It also undermines the validity of the examination, as the weighting and scoring are no longer representative of the intended curriculum and competencies. Furthermore, it creates an environment of distrust and can lead to accusations of bias or favoritism. Another incorrect approach is to have vague and inconsistently applied retake policies. For instance, allowing retakes only at the discretion of individual examiners without a clear, documented framework can lead to arbitrary decisions. This lack of standardization is unfair to candidates who may be held to different standards. It also compromises the reliability of the assessment, as the opportunity to pass the exam is not based on objective criteria but on subjective judgment. This approach fails to uphold the ethical obligation to provide a clear and equitable assessment process. A third incorrect approach is to fail to communicate the blueprint weighting and scoring methodology to candidates until after the examination has been administered. This lack of transparency is a significant ethical failure. Candidates have a right to understand how their performance will be evaluated. Without this information, they cannot adequately prepare for the exam, and the assessment process is inherently unfair. This approach erodes trust in the program and can lead to significant dissatisfaction and potential challenges to the examination’s validity. Professional Reasoning: Professionals should adopt a decision-making framework that prioritizes transparency, fairness, and adherence to established policies. This involves: 1) establishing clear, documented policies for all aspects of assessment, including blueprint weighting, scoring, and retake procedures, with input from relevant stakeholders; 2) ensuring these policies are communicated to candidates well in advance of the examination; 3) applying these policies consistently and objectively to all candidates; and 4) regularly reviewing and updating policies based on feedback and evolving best practices in medical education assessment. When faced with challenging situations, professionals should refer to these established policies and seek guidance from program leadership or ethics committees if ambiguity arises.

Scenario Analysis: This scenario is professionally challenging because fellowship candidates face immense pressure to perform well on exit examinations, which are critical for career progression. The vastness of potential preparation resources and the limited time available necessitate a strategic and evidence-based approach to studying. A candidate’s judgment in selecting and prioritizing resources directly impacts their preparedness and, consequently, their performance and future opportunities. Misjudging this process can lead to wasted effort, increased stress, and ultimately, failure to meet examination standards. Correct Approach Analysis: The best approach involves a structured, multi-modal preparation strategy that prioritizes foundational knowledge, integrates current evidence, and simulates examination conditions. This includes systematically reviewing core internal medicine textbooks and established clinical guidelines, actively engaging with recent high-impact research relevant to women’s health, and utilizing practice questions from reputable sources that mirror the fellowship exit exam format. This method ensures comprehensive coverage, reinforces learning through active recall, and builds confidence by familiarizing the candidate with the examination style and difficulty. Such a systematic and evidence-informed strategy aligns with the ethical obligation of physicians to maintain competence and provide high-quality care, as emphasized by professional medical bodies that advocate for continuous learning and rigorous assessment. Incorrect Approaches Analysis: One incorrect approach is to solely rely on a single, comprehensive review book without supplementing it with current literature or practice questions. This fails to address the dynamic nature of medical knowledge and the specific demands of a fellowship exit exam, which often tests application of knowledge to novel scenarios and recent advancements. It also neglects the importance of active learning and self-assessment. Another incorrect approach is to focus exclusively on practice questions without a solid understanding of the underlying principles. While practice questions are valuable, they are most effective when used to test and reinforce knowledge gained from foundational study. Relying solely on this method can lead to rote memorization without true comprehension, making it difficult to adapt to variations in question phrasing or to apply knowledge to unfamiliar clinical contexts. This approach risks superficial learning and may not adequately prepare the candidate for the depth of understanding required. A third incorrect approach is to prioritize obscure or highly specialized topics over core competencies, based on anecdotal evidence of past exam content. This is a flawed strategy as it deviates from the established curriculum and core competencies expected of a fellow. It also risks neglecting fundamental knowledge areas that are consistently tested. This approach is inefficient and can lead to a skewed understanding of the field, failing to meet the broad requirements of the exit examination. Professional Reasoning: Professionals should approach preparation for high-stakes examinations with a systematic and evidence-based mindset. This involves: 1) Understanding the examination blueprint and scope. 2) Identifying reliable and comprehensive foundational resources. 3) Actively seeking out and integrating current research and guidelines. 4) Employing active learning techniques, including practice questions and case discussions. 5) Regularly self-assessing progress and adjusting the study plan accordingly. This structured approach ensures efficient use of time, promotes deep learning, and builds confidence for successful examination performance.

This scenario is professionally challenging due to the inherent tension between a patient’s autonomy and the physician’s duty of care, particularly when a patient’s decision-making capacity is in question. The physician must navigate complex ethical considerations and potential legal ramifications while ensuring the patient receives appropriate medical management. Careful judgment is required to balance respect for patient wishes with the imperative to prevent harm. The best professional practice involves a systematic and documented assessment of the patient’s decision-making capacity. This approach prioritizes understanding the patient’s current mental state and their ability to comprehend the relevant medical information, appreciate the consequences of their choices, and communicate a choice. If capacity is deemed present, the physician must respect the patient’s refusal of treatment, even if it is not the physician’s preferred course of action, while continuing to offer supportive care and explore alternatives. This aligns with the fundamental ethical principles of autonomy and beneficence, and is supported by general medical ethics guidelines that emphasize informed consent and the right to refuse treatment. An incorrect approach would be to proceed with treatment against the patient’s expressed wishes without a thorough capacity assessment. This disregards the patient’s autonomy and could constitute battery or medical malpractice. Another incorrect approach is to unilaterally assume the patient lacks capacity based on a diagnosis alone, without a formal assessment. This is discriminatory and undermines the patient’s rights. Finally, abandoning the patient or ceasing all communication upon refusal of treatment, without exploring underlying reasons or offering continued support, fails the duty of care and the principle of non-maleficence. Professionals should employ a decision-making framework that begins with a presumption of capacity. If doubt arises, a structured capacity assessment should be conducted, involving clear communication with the patient, exploration of their understanding, and documentation of findings. If capacity is confirmed, the patient’s decision should be respected. If capacity is impaired, the physician must involve surrogate decision-makers or seek legal guidance as appropriate, always acting in the patient’s best interests while respecting their previously expressed wishes if known.

This scenario presents a professional challenge rooted in the ethical imperative of patient autonomy and informed consent, particularly within the context of global health initiatives where cultural nuances and resource limitations can complicate standard practices. The physician must navigate the delicate balance between providing essential medical care and respecting a patient’s right to make decisions about their own health, even when those decisions might not align with the physician’s medical recommendations. Careful judgment is required to ensure that any intervention is not only medically sound but also ethically permissible and culturally sensitive. The best professional approach involves a thorough, culturally sensitive discussion with the patient and her family, exploring the reasons behind their reluctance to accept the recommended surgical intervention. This approach prioritizes understanding the patient’s values, beliefs, and concerns, and then collaboratively exploring alternative management strategies that align with her preferences while still aiming for the best possible health outcome. This respects patient autonomy, upholds the principle of beneficence by seeking the patient’s understanding and agreement, and adheres to ethical guidelines that mandate informed consent and shared decision-making. It also acknowledges the potential impact of cultural factors on healthcare decisions, which is crucial in global women’s health. An incorrect approach would be to proceed with the surgery without fully addressing the family’s concerns, assuming their initial refusal is final or based on misinformation that can be ignored. This fails to uphold the principle of informed consent, as true consent requires understanding and voluntary agreement, which cannot be achieved if underlying concerns are unaddressed. It also risks alienating the patient and her family, potentially leading to non-compliance with post-operative care or a complete breakdown of trust, undermining the long-term health goals. Another incorrect approach would be to dismiss the family’s concerns as purely cultural or traditional and therefore irrelevant to medical decision-making. While cultural factors are important to understand, they should not be used as a reason to disregard a patient’s or family’s deeply held beliefs or fears. This approach is paternalistic and fails to recognize the patient as an autonomous individual whose decisions are shaped by a complex interplay of factors, including cultural context. It violates the ethical principle of respecting individual values and beliefs. Finally, an incorrect approach would be to unilaterally decide that the surgery is necessary and proceed without further dialogue, perhaps believing that the medical benefits outweigh the family’s reservations. This is a paternalistic stance that overrides patient autonomy and the right to self-determination. It assumes the physician knows what is best for the patient without adequately engaging in a shared decision-making process, which is a cornerstone of ethical medical practice, especially in diverse global health settings. The professional reasoning process for similar situations should involve a structured approach: first, actively listen to and empathetically understand the patient’s and family’s concerns, exploring the root causes of their reluctance. Second, provide clear, accessible, and culturally appropriate information about the diagnosis, prognosis, and all available treatment options, including the risks and benefits of each. Third, collaboratively explore alternatives and compromises that respect the patient’s values and preferences while striving for optimal health outcomes. Fourth, document the entire process, including discussions, decisions, and the rationale behind them, ensuring transparency and accountability.

Scenario Analysis: This scenario is professionally challenging because it involves a conflict between a patient’s deeply held cultural beliefs and standard medical practice, directly impacting the patient’s autonomy and the physician’s ethical obligations. The physician must navigate the complexities of informed consent when a patient’s decision-making capacity might be influenced by cultural pressures, while also upholding the principle of beneficence and avoiding harm. The health system’s resources and the potential for differing interpretations of “best interest” further complicate the situation. Correct Approach Analysis: The best professional approach involves a multi-faceted strategy that prioritizes patient autonomy and cultural sensitivity while ensuring the patient receives adequate information for informed consent. This includes engaging in open, non-judgmental dialogue with the patient and her family, exploring the cultural underpinnings of her decision, and providing clear, understandable information about the medical risks and benefits of the proposed treatment and alternative options, including palliative care. The physician should also explore whether the patient’s decision is truly her own or influenced by coercion, and involve a cultural liaison or ethics committee if necessary to bridge understanding and facilitate a truly informed decision. This aligns with ethical principles of respect for autonomy, beneficence, and non-maleficence, and the principles of health systems science by seeking to understand the patient within her socio-cultural context and utilizing available resources for effective communication and decision-making. Incorrect Approaches Analysis: Proceeding with the surgery without further discussion, assuming the patient’s consent is valid despite potential cultural pressures, fails to uphold the principle of informed consent. It disregards the potential for coercion or misunderstanding and prioritizes a procedural interpretation of consent over a substantive one, potentially leading to patient harm and violating autonomy. Immediately overriding the patient’s decision and proceeding with the standard medical recommendation, citing the potential for harm, disrespects patient autonomy and cultural beliefs. While beneficence is a consideration, it cannot be pursued by disregarding a patient’s right to make decisions about her own body, especially when capacity is not demonstrably impaired. This approach fails to engage in the necessary dialogue to understand the patient’s perspective and explore alternatives. Consulting only the patient’s husband for consent, without direct and thorough engagement with the patient herself, is a significant ethical and regulatory failure. It undermines the patient’s autonomy and may violate principles of gender equality in healthcare decision-making, even within a cultural context. While family involvement is often important, the primary consent must come from the capacitated patient. Professional Reasoning: Professionals should employ a shared decision-making model that emphasizes open communication, active listening, and respect for patient values and beliefs. When cultural factors intersect with medical decisions, it is crucial to seek to understand the cultural context without judgment. This involves assessing the patient’s understanding, exploring her preferences and concerns, and clearly articulating medical options, risks, and benefits. If there are concerns about coercion or impaired capacity, these should be addressed through careful assessment and, if necessary, consultation with ethics committees or cultural experts. The goal is to empower the patient to make a decision that is both informed and aligned with her values, within the bounds of safe medical practice.