This scenario presents a professionally challenging situation due to the inherent complexities of interdisciplinary collaboration in high-stakes environments like trauma theaters and critical care units. The challenge lies in balancing the immediate need for decisive action with the ethical imperative of respecting the expertise and autonomy of all team members, particularly when differing opinions arise regarding patient care. Careful judgment is required to navigate potential conflicts, ensure patient safety, and maintain a functional, respectful team dynamic. The best professional approach involves a structured, collaborative discussion to reach a consensus, prioritizing patient well-being. This entails actively listening to all perspectives, acknowledging the validity of differing viewpoints, and facilitating a process where the team collectively agrees on the most appropriate course of action. This aligns with ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm), as well as professional guidelines that emphasize teamwork and communication in critical care settings. Such an approach fosters shared responsibility and leverages the collective knowledge of the team, ultimately leading to better patient outcomes. An approach that dismisses the concerns of a junior team member without thorough consideration is professionally unacceptable. This failure to engage with a valid concern, even if it originates from a less experienced individual, violates the principle of respect for persons and can lead to suboptimal care if the concern was indeed valid. It also undermines the learning environment and discourages open communication, which are crucial for a high-functioning trauma team. Another professionally unacceptable approach is to unilaterally make a decision without seeking input or consensus from the entire team, especially when there is a clear divergence of opinion. This demonstrates a lack of respect for the expertise of other team members and can lead to resentment and a breakdown in team cohesion. It also bypasses the opportunity to benefit from diverse perspectives, which can be critical in complex trauma cases. Finally, an approach that involves escalating the disagreement to a higher authority immediately, without first attempting to resolve it through direct team discussion and consensus-building, can be seen as a failure to adequately utilize the team’s problem-solving capacity. While escalation may be necessary in some situations, it should not be the first resort when collaborative resolution is feasible and appropriate. This can create unnecessary bureaucracy and can be perceived as a lack of confidence in the team’s ability to manage its own challenges. Professionals should employ a decision-making framework that prioritizes open communication, active listening, and collaborative problem-solving. When faced with differing opinions, the process should involve: 1) ensuring all voices are heard and respected, 2) clearly articulating the rationale behind each perspective, 3) facilitating a discussion to identify common ground and potential solutions, and 4) collectively agreeing on a course of action that best serves the patient. If consensus cannot be reached, a clear, pre-defined escalation protocol should be followed, ensuring that the ultimate decision is made with the patient’s best interest as the paramount consideration.

This scenario presents a significant ethical dilemma common in trauma surgery, revolving around patient autonomy, informed consent, and the physician’s duty of care when faced with a patient who may not fully grasp the gravity of their situation due to their condition. The professional challenge lies in balancing the immediate need for life-saving intervention with the patient’s right to self-determination, especially when capacity is questionable. The urgency of the trauma situation often compresses the time available for thorough assessment and discussion, increasing the risk of either overriding a competent patient’s wishes or delaying necessary care. The best professional approach involves a systematic assessment of the patient’s decision-making capacity. This entails determining if the patient can understand the relevant information about their condition, the proposed treatment, the alternatives, and the consequences of refusing treatment. If capacity is present, their informed refusal must be respected, even if it leads to a poor outcome. If capacity is absent or significantly impaired, the physician must act in the patient’s best interest, which may involve proceeding with life-saving surgery under the principle of implied consent in emergency situations, or seeking surrogate decision-makers if available and time permits. This aligns with the ethical principles of beneficence and non-maleficence, while also respecting the patient’s right to autonomy as much as possible given the circumstances. Regulatory frameworks, such as those guiding medical practice in North America, emphasize the importance of informed consent and patient autonomy, but also provide for exceptions in emergent situations where a patient is unable to consent and delay would result in serious harm or death. An approach that prioritizes immediate surgical intervention without a reasonable attempt to assess capacity or identify surrogate decision-makers, even if the patient appears disoriented, fails to uphold the principle of patient autonomy. While beneficence is a consideration, it cannot unilaterally override a patient’s right to refuse treatment if they possess the capacity to make that decision. This could lead to legal and ethical repercussions for violating patient rights. Another unacceptable approach would be to delay necessary life-saving surgery solely due to the patient’s apparent disorientation, without actively seeking to assess their capacity or explore options for obtaining consent. This inaction, when a clear and present danger to life exists, could be construed as a failure of the physician’s duty to provide timely and appropriate care, potentially violating the principle of non-maleficence by allowing harm to occur that could have been prevented. Finally, an approach that relies solely on the family’s wishes without a thorough assessment of the patient’s capacity or the family’s legal standing as surrogate decision-makers is problematic. While family input is valuable, the ultimate decision-making authority, in the absence of a patient’s capacity, typically rests with legally appointed surrogates or follows established legal protocols for emergency situations. The professional decision-making process in such situations should involve a rapid, yet thorough, assessment of the patient’s capacity to consent. This includes evaluating their ability to comprehend the situation, the proposed treatment, alternatives, and the risks and benefits. If capacity is present, their informed decision must be respected. If capacity is lacking, the physician should explore the availability of advance directives or identify appropriate surrogate decision-makers according to established legal and ethical guidelines. In true emergencies where no surrogate is available and delay would be detrimental, the principle of implied consent for life-saving interventions applies. Documentation of the assessment, the decision-making process, and the rationale for any action taken is crucial.

The control framework reveals a complex ethical dilemma in managing a critically injured patient with limited resources and competing demands. This scenario is professionally challenging due to the inherent tension between providing immediate, life-saving care to one patient and the ethical obligation to consider the needs of other potential patients who may also require urgent surgical intervention. The scarcity of resources, particularly surgical time and personnel, necessitates difficult prioritization decisions, demanding a balance between beneficence, non-maleficence, justice, and professional responsibility. Careful judgment is required to navigate these competing ethical principles and ensure the most appropriate and equitable allocation of care. The approach that represents best professional practice involves a rapid, objective assessment of the patient’s physiological status and the likelihood of survival with immediate surgical intervention, balanced against the potential for other patients to benefit from the same resources. This requires adherence to established trauma triage protocols and clinical guidelines that prioritize patients with the highest probability of survival and the greatest potential for meaningful recovery. Specifically, this involves a systematic evaluation of the patient’s Injury Severity Score (ISS), Glasgow Coma Scale (GCS), vital signs, and the nature of their injuries. If the patient’s condition is deemed unsalvageable or if the resources required for their intervention would definitively preclude saving other patients with a higher likelihood of survival, then palliative care and comfort measures are initiated. This approach aligns with the ethical principle of justice, ensuring that resources are allocated fairly and efficiently to maximize the overall benefit to the patient population. It also upholds non-maleficence by avoiding futile interventions that may prolong suffering without a reasonable chance of recovery. An incorrect approach would be to proceed with surgery solely based on the patient being the first to arrive or due to emotional distress from the family, without a thorough objective assessment of their survivability and resource implications. This fails to consider the principle of justice and the efficient allocation of scarce resources, potentially diverting critical surgical time and expertise from patients who have a higher probability of survival and a better outcome. Another incorrect approach would be to unilaterally decide to withhold surgery without consulting with the trauma team, including other surgeons, anesthesiologists, and nursing staff, and without attempting to communicate the rationale to the patient’s family. This violates principles of collaborative decision-making and professional communication, potentially leading to mistrust and distress. Finally, an incorrect approach would be to delay definitive surgical management to await further diagnostic tests that are unlikely to alter the immediate management decision or the patient’s prognosis, especially when the patient is hemodynamically unstable. This could lead to irreversible deterioration and a missed opportunity for life-saving intervention, contravening the principle of beneficence. The professional reasoning process for similar situations should involve a structured, multidisciplinary approach. This includes immediate scene assessment (if applicable), rapid primary and secondary surveys, objective scoring systems (like ISS and GCS), and a clear understanding of available resources. Open communication within the trauma team is paramount, followed by transparent and empathetic communication with the patient’s family, explaining the clinical situation, the rationale for the management plan, and the ethical considerations involved. When faced with resource limitations, the decision-making framework must prioritize interventions that offer the greatest chance of survival and meaningful recovery for the greatest number of patients, guided by established protocols and ethical principles.

The control framework reveals a situation where a surgeon’s personal beliefs may conflict with the immediate needs of a critically injured patient requiring a life-saving procedure. This scenario is professionally challenging because it pits the surgeon’s autonomy and ethical right to refuse participation in procedures against their professional obligation to provide care and the patient’s right to life-saving treatment. The urgency of the trauma situation, coupled with the potential for irreversible harm or death if the procedure is delayed, heightens the ethical stakes and necessitates swift, principled decision-making. The best professional approach involves prioritizing the patient’s immediate well-being and the principles of medical ethics, specifically beneficence and non-maleficence, while respecting the surgeon’s conscience. This approach entails the surgeon immediately informing the attending trauma team leader of their inability to participate due to personal ethical objections. Crucially, the surgeon must then actively facilitate the transfer of care to another qualified surgeon without delay, ensuring continuity of care and minimizing any potential harm to the patient. This respects the surgeon’s ethical stance while upholding the paramount duty to the patient. This aligns with professional guidelines that emphasize patient advocacy and the need for timely, appropriate medical intervention, even when personal beliefs are involved. The ethical framework supports a surgeon’s right to conscientious objection but mandates that such objections do not compromise patient care. An approach where the surgeon proceeds with the surgery despite personal ethical objections, suppressing their beliefs to avoid patient harm, fails to uphold the principle of honesty and integrity. While the outcome might be positive for the patient, the internal conflict and lack of transparency can lead to psychological distress for the surgeon and potentially impact future decision-making. It bypasses the established mechanisms for managing conscientious objection. Another unacceptable approach is for the surgeon to refuse to participate and then do nothing further, leaving the patient’s care in immediate jeopardy. This directly violates the professional obligation to act in the patient’s best interest and constitutes a dereliction of duty. It prioritizes the surgeon’s personal comfort over the patient’s life-saving needs and ignores the ethical imperative to ensure continuity of care. A further incorrect approach would be for the surgeon to attempt to persuade the patient or their family to delay or refuse the necessary procedure based on their personal ethical objections. This is a profound ethical breach, as it inappropriately imposes the surgeon’s personal beliefs onto the patient’s decision-making process and undermines patient autonomy. The professional reasoning process in such situations should involve: 1) Immediate recognition of the ethical conflict. 2) Prioritizing the patient’s immediate medical needs. 3) Communicating the inability to participate due to ethical objections clearly and promptly to the appropriate authority (e.g., team leader). 4) Actively and efficiently facilitating the transfer of care to another qualified provider. 5) Documenting the situation and the actions taken. This structured approach ensures that patient care remains paramount while respecting the ethical boundaries of all involved.

The control framework reveals a scenario demanding immediate and ethically sound decision-making in a high-stakes surgical environment. The professional challenge lies in balancing the urgent need for definitive surgical intervention with the patient’s right to informed consent, especially when the patient’s capacity to consent is compromised due to their critical condition. This situation requires a nuanced understanding of medical ethics, patient autonomy, and established legal precedents regarding emergency medical treatment. The best approach involves prioritizing the patient’s immediate well-being while diligently seeking to uphold their autonomy as much as possible. This means proceeding with life-saving surgery after making a good-faith effort to obtain consent from a surrogate decision-maker, or, if no surrogate is immediately available and the situation is life-threatening, acting in the patient’s presumed best interest based on accepted medical standards. This aligns with the ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm), while also respecting the principle of autonomy by attempting to involve a surrogate or acting in a way that a reasonable person would consent to if they were able. Regulatory frameworks generally support such actions in emergent situations where delay would result in irreversible harm or death. An incorrect approach would be to delay life-saving surgery indefinitely while attempting to locate a distant family member or waiting for the patient to regain full consciousness, thereby risking irreversible harm or death. This fails the principle of beneficence and could be considered medical negligence. Another incorrect approach would be to proceed with surgery without any attempt to contact a surrogate or document the emergent nature of the situation, which could be seen as a violation of the patient’s right to autonomy and could lead to legal repercussions, even if the surgery was ultimately successful. Proceeding with surgery based on the assumption of consent without any documented effort to ascertain the patient’s wishes or involve a surrogate, especially when the patient has expressed prior wishes or has a known advance directive, would also be ethically and potentially legally problematic. Professionals should employ a decision-making framework that begins with assessing the immediate threat to life and the patient’s capacity to consent. If capacity is compromised, the next step is to identify and involve a legally recognized surrogate decision-maker. If no surrogate is available and the situation is emergent, the decision to proceed with treatment should be based on the patient’s presumed best interest, with thorough documentation of the rationale and the emergent circumstances. This process emphasizes a commitment to both patient safety and ethical patient care.

The control framework reveals a critical juncture in assessing surgical competency, specifically concerning the blueprint weighting, scoring, and retake policies for the Critical North American Trauma Systems Surgery Competency Assessment. This scenario is professionally challenging because it pits the imperative of ensuring patient safety and maintaining high standards of surgical practice against the need for fairness and support for trainees. Misinterpreting or misapplying the assessment’s policies can lead to either compromised patient care due to inadequately assessed surgeons or undue hardship and potential career derailment for competent surgeons who face unfair evaluation. Careful judgment is required to balance these competing interests within the established regulatory and ethical guidelines. The best professional approach involves a thorough review of the official assessment blueprint and accompanying policy documents to understand the rationale behind the established weighting and scoring mechanisms. This approach prioritizes adherence to the established, validated framework designed to objectively measure competency. If a discrepancy or perceived unfairness arises, the correct course of action is to formally appeal through the designated channels outlined in the assessment’s retake policy, providing specific evidence and justification for the concern. This aligns with principles of procedural fairness and due process, ensuring that any challenges to the assessment are addressed systematically and transparently, respecting the integrity of the evaluation process while allowing for correction of potential errors. An incorrect approach would be to unilaterally adjust scoring or weighting based on personal judgment or anecdotal evidence of a candidate’s overall performance outside the defined assessment criteria. This undermines the standardized nature of the competency assessment, introducing subjectivity and potentially compromising the validity of the results. It fails to respect the established control framework and could lead to the certification of individuals who do not meet the objective standards, thereby jeopardizing patient safety. Another professionally unacceptable approach is to allow a candidate to retake the assessment without adhering to the specified retake policy, such as waiving fees or providing additional, non-standardized preparation. This creates an inequitable situation for other candidates and bypasses the established procedures designed to ensure fairness and consistency in the retake process. It also fails to address the underlying reasons for the initial assessment outcome, potentially leading to repeated failures without adequate remediation. Furthermore, an incorrect approach involves publicly questioning or disregarding the established scoring and weighting without following the formal appeal process. This can erode confidence in the assessment system and create an unprofessional environment. It also fails to provide a constructive pathway for addressing concerns and instead promotes discord. The professional decision-making process for similar situations should involve a commitment to understanding and adhering to established policies and procedures. When faced with a perceived issue, the first step should always be to consult the relevant documentation. If clarification or correction is needed, the appropriate formal channels for appeal or inquiry should be utilized. This ensures that decisions are made based on evidence, fairness, and adherence to the established framework, upholding both professional integrity and the safety of the public.

The control framework reveals a critical juncture for a surgeon preparing for the Critical North American Trauma Systems Surgery Competency Assessment. This scenario is professionally challenging because it pits the immediate pressure of a demanding assessment against the ethical imperative of ensuring genuine competence and patient safety, even in a simulated environment. The candidate’s approach to preparation directly impacts their ability to perform under pressure and uphold the standards expected of trauma surgeons. Careful judgment is required to balance efficient preparation with thorough understanding and ethical conduct. The best approach involves a structured, self-directed study plan that prioritizes understanding core principles and practicing critical decision-making skills, supplemented by targeted review of assessment-specific materials. This method is correct because it aligns with the ethical obligation of a medical professional to achieve and maintain demonstrable competence. It reflects a commitment to deep learning rather than superficial memorization, which is crucial for high-stakes surgical assessments. Furthermore, it respects the integrity of the assessment process by ensuring the candidate is genuinely prepared, not just adept at test-taking strategies. This approach fosters a robust understanding of trauma systems surgery, which is paramount for patient care. An approach that focuses solely on memorizing past exam questions and answers is professionally unacceptable. This fails to address the ethical requirement of developing true clinical judgment and problem-solving skills. While it might lead to a higher score on a specific assessment, it does not guarantee the candidate’s ability to handle real-world trauma scenarios, potentially jeopardizing patient safety. This method prioritizes test performance over genuine competence, which is an ethical failing. Another unacceptable approach is to rely exclusively on informal study groups without structured learning or expert guidance. While collaboration can be beneficial, an over-reliance on informal discussions can lead to the propagation of misinformation or incomplete understanding. It bypasses the ethical responsibility to seek out authoritative knowledge and validated learning resources, potentially leading to gaps in critical knowledge areas essential for trauma surgery. Finally, an approach that involves seeking advanced knowledge of the assessment’s specific scoring algorithms or “insider” information about question patterns, rather than focusing on the surgical competencies themselves, is ethically unsound. This undermines the fairness and validity of the assessment process. The ethical duty is to demonstrate mastery of the subject matter, not to exploit loopholes or gain an unfair advantage, which could ultimately compromise the quality of care provided to patients. Professionals should approach preparation for competency assessments by first understanding the scope of practice and the specific competencies being evaluated. They should then develop a learning plan that incorporates a variety of resources, including textbooks, peer-reviewed literature, simulation, and expert mentorship. Regular self-assessment and seeking feedback are crucial to identify areas needing further development. The ultimate goal is not just to pass an exam, but to become a more competent and safer practitioner.

This scenario presents a significant ethical and professional challenge due to the inherent conflict between a surgeon’s desire to provide optimal care and the potential for unforeseen complications that could impact patient safety and the integrity of the surgical plan. The critical nature of trauma surgery amplifies these challenges, demanding meticulous preparation and a robust risk mitigation strategy. The correct approach involves a comprehensive, multi-disciplinary pre-operative planning session that explicitly addresses potential complications and outlines contingency plans. This includes detailed discussion of alternative surgical approaches, necessary equipment, and the roles of each team member. This aligns with ethical principles of beneficence (acting in the patient’s best interest) and non-maleficence (avoiding harm) by proactively identifying and planning for risks. Furthermore, it adheres to professional standards of care that mandate thorough preparation and communication within the surgical team, fostering a culture of safety and accountability. This structured planning process is essential for informed consent and ensures that the entire team is prepared to manage unexpected events, thereby minimizing patient harm. An incorrect approach would be to proceed with a less detailed plan, assuming the surgeon’s experience will be sufficient to manage any emergent issues. This fails to adequately address the ethical obligation to minimize risk and can lead to delayed decision-making or suboptimal management during a critical event. It also undermines the principle of shared responsibility within the surgical team. Another incorrect approach would be to defer detailed contingency planning until intra-operative findings dictate it. This neglects the proactive risk mitigation required in complex trauma cases. It places undue pressure on the surgeon and team in a high-stress environment and may result in a lack of necessary resources or expertise being readily available, increasing the likelihood of adverse outcomes. Finally, an approach that prioritizes speed over thoroughness in planning, perhaps due to time pressures or a perceived urgency, is also professionally unacceptable. While time is often of the essence in trauma, a rushed or incomplete plan can inadvertently introduce new risks or exacerbate existing ones. True efficiency in trauma surgery stems from well-executed, prepared plans, not from cutting corners in the planning phase. Professionals should employ a systematic decision-making framework that prioritizes patient safety and ethical conduct. This involves: 1) thorough pre-operative assessment and information gathering; 2) collaborative planning with all relevant team members, including explicit discussion of potential complications and mitigation strategies; 3) clear communication of the plan and individual responsibilities; and 4) a commitment to continuous re-evaluation and adaptation during the procedure while adhering to the established safety protocols.

This scenario presents a significant ethical and professional challenge due to the inherent conflict between the patient’s immediate physiological needs and the potential for long-term harm from an unindicated procedure. The surgeon must balance the urgency of trauma care with the principles of beneficence, non-maleficence, and patient autonomy, all within the framework of established surgical standards and ethical guidelines. The pressure of a critical situation can sometimes lead to a temptation to act decisively without fully exploring all diagnostic and therapeutic options, making careful judgment paramount. The best approach involves a thorough, albeit rapid, assessment of the patient’s hemodynamic stability and the anatomical structures involved, prioritizing interventions that directly address life threats while minimizing unnecessary tissue disruption. This includes a meticulous intraoperative examination to confirm the necessity of the proposed resection based on clear anatomical evidence of irreparable damage or uncontrolled hemorrhage that cannot be managed by less invasive means. The justification for this approach lies in the fundamental surgical principle of “primum non nocere” (first, do no harm). Performing an extensive resection without absolute anatomical indication risks significant morbidity, including loss of function, increased infection risk, and prolonged recovery, without a clear commensurate benefit to the patient’s survival or immediate well-being. Adherence to evidence-based surgical practices and the ethical obligation to provide care that is both necessary and proportionate to the patient’s condition are central to this decision. An approach that proceeds with the extensive resection based solely on a presumptive diagnosis or a desire to “err on the side of caution” without definitive anatomical confirmation of irreparable damage is professionally unacceptable. This bypasses the critical step of verifying the necessity of such a drastic intervention, potentially leading to iatrogenic harm. It violates the principle of non-maleficence by inflicting harm (tissue loss) that is not justified by the patient’s condition. Another professionally unacceptable approach would be to delay definitive surgical management due to indecision or an overemphasis on less invasive measures when the anatomical findings clearly indicate the need for immediate, decisive surgical intervention to control hemorrhage or repair vital structures. This could lead to irreversible physiological deterioration and a worse outcome for the patient, failing the duty of care. Finally, proceeding with the resection without adequately considering the potential for less invasive salvage techniques, if anatomically feasible and indicated, would also be professionally unsound. This demonstrates a lack of comprehensive surgical planning and an unwillingness to explore all appropriate options to preserve function and minimize patient burden. The professional reasoning process in such a situation should involve a rapid but systematic evaluation: 1. Assess the immediate physiological threat: Is the patient hemodynamically unstable due to the identified injury? 2. Confirm anatomical findings: What specific structures are injured, and to what extent? Is the damage irreparable by less invasive means? 3. Consider therapeutic options: What are the available surgical interventions, ranging from conservative to radical? 4. Weigh risks and benefits: What are the potential harms and benefits of each intervention in the context of the patient’s overall condition and prognosis? 5. Prioritize interventions: Select the intervention that most effectively addresses the immediate threat while minimizing iatrogenic harm and preserving function. 6. Document thoroughly: Maintain clear and accurate records of findings, decisions, and interventions.

The control framework reveals a scenario that is professionally challenging due to the inherent conflict between patient autonomy, the physician’s duty of care, and the potential for resource allocation issues within a high-pressure trauma setting. The need for immediate, life-saving intervention clashes with the patient’s right to refuse treatment, even if that refusal is based on a temporary or potentially reversible state of impaired judgment. Careful judgment is required to navigate these competing ethical and professional obligations. The approach that represents best professional practice involves a multi-faceted strategy focused on ensuring the patient’s safety and well-being while respecting their rights as much as possible. This includes a thorough assessment of the patient’s capacity to make informed decisions, seeking to understand the reasons behind their refusal, and involving a multidisciplinary team, including ethics consultation if necessary. If the patient is deemed to lack capacity due to their acute medical condition (e.g., shock, intoxication, or delirium), the physician has a professional and ethical obligation to provide necessary life-saving treatment in accordance with established medical standards and institutional policies, acting in the patient’s best interest. This aligns with the principles of beneficence and non-maleficence, and the legal concept of implied consent in emergency situations where a patient is unable to consent. An approach that prioritizes immediate, forceful intervention without a comprehensive assessment of capacity or an attempt to understand the patient’s wishes, even if they are impaired, fails to uphold the principle of respect for autonomy. While the intent may be to save a life, it bypasses crucial ethical steps and could lead to legal challenges if the patient later regains capacity and asserts their right to have refused treatment. Another incorrect approach would be to simply accept the patient’s refusal without further investigation, even if there are clear signs of impaired judgment or a life-threatening condition. This would violate the physician’s duty of care and the principle of beneficence, potentially leading to preventable harm or death. Finally, an approach that delays necessary life-saving treatment to exhaust all possible avenues of communication or to seek external approval beyond what is standard in emergency protocols, without a clear indication that the patient possesses capacity, could also be professionally unacceptable. The urgency of trauma care necessitates timely decision-making, and while thoroughness is important, it must be balanced with the immediate need for intervention when a patient’s life is at stake and capacity is questionable. Professional reasoning in such situations should follow a structured process: 1) Rapidly assess the patient’s medical stability and the immediate threat to life. 2) Simultaneously, assess the patient’s capacity to make informed decisions about their treatment. This involves evaluating their ability to understand the information, appreciate the consequences of their decision, and communicate their choice. 3) If capacity is questionable or absent, attempt to identify a surrogate decision-maker. 4) If no surrogate is available and the patient lacks capacity, proceed with life-saving treatment based on the principle of acting in the patient’s best interest, documenting all assessments and decisions thoroughly. 5) Engage ethics consultation or legal counsel if the situation is complex or there is significant doubt about the appropriate course of action.