The investigation demonstrates a scenario common in rural generalist medicine where limited resources and geographical isolation create complex ethical challenges. The professional challenge lies in balancing the immediate needs of a patient with the long-term implications of resource allocation and professional boundaries. Careful judgment is required to navigate these competing demands ethically and effectively. The best approach involves prioritizing patient safety and well-being while adhering to professional ethical codes and seeking appropriate consultation. This means immediately addressing the patient’s acute condition with the available resources, documenting all interventions thoroughly, and then proactively engaging with the patient and relevant healthcare authorities to arrange for definitive care and address the underlying issues of access and resource limitations. This aligns with the ethical principles of beneficence (acting in the patient’s best interest), non-maleficence (avoiding harm), and justice (fair distribution of resources and care). It also respects the patient’s autonomy by involving them in the decision-making process regarding their ongoing care. An incorrect approach would be to dismiss the patient’s concerns due to perceived lack of immediate resources or to unilaterally decide against further intervention without exploring all avenues. This fails to uphold the duty of care owed to the patient and could lead to harm. Another incorrect approach is to provide a definitive treatment that is beyond the scope of the rural generalist’s expertise or available equipment without proper consultation or transfer arrangements. This risks patient harm due to inadequate care and constitutes practicing outside of one’s competence. Finally, an approach that involves delaying necessary care or making promises of care that cannot be realistically delivered due to resource constraints is ethically unsound and erodes patient trust. Professionals facing similar situations should employ a structured decision-making process. This involves: 1) Rapidly assessing the patient’s immediate needs and risks. 2) Identifying available resources and limitations. 3) Consulting with colleagues, specialists, or relevant health authorities to explore options for care and transfer. 4) Communicating openly and honestly with the patient about their condition, available options, and the rationale behind decisions. 5) Documenting all assessments, interventions, consultations, and patient discussions meticulously. 6) Advocating for improved resources and access to care within the community.

Scenario Analysis: This scenario presents a professional challenge because the candidate is seeking to leverage their existing knowledge and experience to prepare for a competency assessment. The ethical dilemma arises from ensuring that the preparation methods are both effective and compliant with professional standards, avoiding any shortcuts that could compromise the integrity of the assessment or the candidate’s genuine understanding. The need for careful judgment stems from balancing the desire for efficient preparation with the obligation to adhere to ethical guidelines and regulatory expectations for demonstrating competence. Correct Approach Analysis: The best professional practice involves a structured and comprehensive approach to preparation that aligns with the stated competencies and recommended resources. This includes dedicating sufficient time to review the official curriculum, practice with sample assessments provided by the assessing body, and engage in peer discussions or study groups focused on the specific knowledge domains. This approach is correct because it directly addresses the assessment’s requirements, utilizes approved materials, and fosters a deep understanding of the subject matter, thereby ensuring the candidate is genuinely prepared and meeting the standards set by the regulatory framework for rural generalist medicine in North America. It prioritizes authentic learning and assessment readiness over superficial engagement. Incorrect Approaches Analysis: One incorrect approach involves relying solely on informal study groups and anecdotal advice from colleagues who have previously taken the assessment. This is professionally unacceptable because it bypasses the official curriculum and recommended resources, potentially leading to gaps in knowledge or a misunderstanding of the assessment’s scope and emphasis. It risks preparing based on outdated or incomplete information, failing to meet the rigorous standards expected for demonstrating competency in rural generalist medicine. Another incorrect approach is to focus exclusively on memorizing answers to past exam questions without understanding the underlying principles. This is ethically flawed as it prioritizes passing the assessment through rote learning rather than genuine comprehension and application of medical knowledge. It fails to equip the candidate with the critical thinking and problem-solving skills necessary for rural generalist practice, thereby undermining the purpose of the competency assessment and potentially endangering patient care. A further incorrect approach is to allocate minimal preparation time, assuming prior experience is sufficient, and only reviewing material a few days before the assessment. This is professionally irresponsible as it demonstrates a lack of commitment to thorough preparation and a disregard for the importance of the competency assessment. It fails to acknowledge the potential for new guidelines, evolving practices, or specific nuances within the rural generalist scope that require dedicated study, thus not adequately demonstrating the required level of competence. Professional Reasoning: Professionals should approach competency assessments with a mindset of continuous learning and a commitment to demonstrating mastery. The decision-making process should involve: 1) Thoroughly understanding the assessment’s objectives and scope by consulting official documentation. 2) Identifying and utilizing all recommended preparation resources provided by the assessing body. 3) Developing a realistic and structured study timeline that allows for in-depth review and practice. 4) Seeking clarification on any uncertainties through appropriate channels. 5) Prioritizing genuine understanding and application of knowledge over superficial memorization or shortcuts.

This scenario presents a common ethical and professional challenge in rural generalist medicine, particularly concerning the management of chronic conditions and the application of evidence-based practice within resource constraints. The core difficulty lies in balancing the patient’s expressed preferences and perceived needs with the physician’s professional obligation to provide care aligned with current best practices and available evidence, while also considering the practical limitations of a rural setting. The physician must navigate potential conflicts between patient autonomy, beneficence, and the principle of justice (equitable access to appropriate care). The best approach involves a shared decision-making process that prioritizes patient education and collaborative goal setting, grounded in evidence-based guidelines. This approach begins by acknowledging the patient’s concerns and experiences, then clearly articulating the evidence supporting a particular management strategy, explaining the rationale behind it, and discussing potential benefits and risks in an understandable manner. Crucially, it involves exploring the patient’s values, preferences, and barriers to adherence, and then collaboratively developing a treatment plan that is both evidence-informed and realistically achievable for the patient within their rural context. This respects patient autonomy while fulfilling the physician’s duty of care and promoting optimal health outcomes. This aligns with the ethical principles of informed consent and shared decision-making, which are fundamental to professional medical practice and are implicitly supported by guidelines promoting patient-centered care. An incorrect approach would be to dismiss the patient’s concerns outright and unilaterally impose a treatment plan based solely on the physician’s interpretation of evidence, without adequately engaging the patient in the decision-making process. This fails to respect patient autonomy and can lead to poor adherence and dissatisfaction. It also overlooks the importance of understanding the patient’s lived experience and potential barriers to care, which are critical in rural settings. Another incorrect approach would be to accede to the patient’s request for a treatment that is demonstrably not evidence-based or potentially harmful, without thoroughly exploring the underlying reasons for their preference or attempting to educate them on alternatives. This prioritizes patient preference over beneficence and professional responsibility, potentially leading to suboptimal or detrimental health outcomes. It also fails to uphold the physician’s role as a trusted advisor and educator. A further incorrect approach would be to avoid the discussion altogether due to time constraints or perceived difficulty, and simply continue with the existing, potentially suboptimal, management plan. This represents a failure to engage in proactive, evidence-based care and a missed opportunity to improve the patient’s health and well-being. It can perpetuate a cycle of ineffective treatment and patient disengagement. Professionals should employ a structured decision-making process that includes: actively listening to and validating patient concerns; clearly communicating evidence-based recommendations with supporting rationale; assessing patient understanding, values, and preferences; identifying and addressing barriers to care; and collaboratively developing a mutually agreeable and achievable treatment plan. This process emphasizes communication, education, and partnership.

Scenario Analysis: This scenario presents a professional challenge rooted in the intersection of patient autonomy, resource allocation within a rural health system, and the ethical imperative to provide equitable care. Dr. Anya Sharma faces a conflict between a patient’s expressed wishes, which may be influenced by incomplete understanding or external pressures, and the physician’s duty to act in the patient’s best interest, particularly when limited resources necessitate difficult choices. The rural setting exacerbates this by potentially limiting access to alternative opinions or specialized care, placing a greater burden on the generalist to navigate complex ethical terrain. Careful judgment is required to balance respect for the patient’s self-determination with the physician’s professional responsibility and the practical realities of the healthcare system. Correct Approach Analysis: The best professional practice involves a comprehensive and empathetic approach to informed consent that prioritizes patient understanding and shared decision-making. This includes thoroughly explaining the proposed treatment, its benefits, risks, and alternatives, and actively assessing the patient’s comprehension. It also necessitates exploring the underlying reasons for the patient’s refusal, addressing any fears or misconceptions, and offering support to facilitate a decision that aligns with their values and best interests. This approach is ethically justified by the fundamental principle of patient autonomy, which mandates that individuals have the right to make informed decisions about their own healthcare, and the principle of beneficence, which requires physicians to act in the patient’s best interest, which includes ensuring their decisions are truly informed. Regulatory frameworks, such as those governing medical practice in North America, emphasize the importance of obtaining valid informed consent, which requires not just disclosure but also comprehension and voluntariness. Incorrect Approaches Analysis: One incorrect approach involves accepting the patient’s refusal without further exploration, assuming their decision is fully informed and autonomous. This fails to uphold the physician’s duty of beneficence and can lead to suboptimal patient outcomes if the refusal is based on misinformation or coercion. Ethically, it neglects the physician’s role in ensuring the patient’s decision is truly informed and voluntary. Another incorrect approach is to override the patient’s wishes based on the physician’s judgment of what is medically best, without adequately addressing the patient’s concerns or exploring alternatives. This violates the principle of patient autonomy and can erode trust in the physician-patient relationship. It also fails to acknowledge the patient’s right to self-determination, even if their choices differ from the physician’s recommendation. A third incorrect approach involves pressuring the patient to accept the recommended treatment by emphasizing the limited availability of alternative options or the potential negative consequences of refusal without offering sufficient support or exploring the patient’s perspective. This constitutes undue influence and undermines the voluntariness aspect of informed consent, potentially leading to a decision that is not truly autonomous. Professional Reasoning: Professionals should employ a decision-making framework that begins with a thorough assessment of the patient’s understanding and values. This involves active listening, clear communication, and a non-judgmental exploration of the patient’s concerns. When faced with a patient’s refusal of recommended care, the professional should engage in a process of shared decision-making, ensuring all reasonable alternatives have been discussed and understood, and that the patient’s decision is respected if it is informed and voluntary. If there are concerns about the patient’s capacity to make such a decision, appropriate steps should be taken to assess capacity and involve surrogate decision-makers if necessary, always prioritizing the patient’s well-being and autonomy within the ethical and legal boundaries.

Scenario Analysis: This scenario is professionally challenging because it requires a rural generalist physician to navigate the specific requirements and purpose of a competency assessment designed for their unique practice setting. Misunderstanding the assessment’s intent or eligibility criteria can lead to wasted resources, professional frustration, and potentially delayed or denied access to essential professional development or credentialing. Careful judgment is required to align personal career goals and practice needs with the assessment’s stated objectives and the regulatory framework governing rural generalist medicine in North America. Correct Approach Analysis: The best approach is to thoroughly review the official documentation outlining the purpose and eligibility criteria for the Frontline North American Rural Generalist Medicine Competency Assessment. This involves understanding that the assessment is designed to evaluate the specific skills and knowledge required for effective practice in rural settings, often encompassing a broader scope of practice than urban generalism. Eligibility typically hinges on factors such as current practice location, patient population served, and the physician’s commitment to rural healthcare. Adhering to these documented requirements ensures that the physician is pursuing the assessment for its intended purpose and meets the foundational criteria for participation, aligning with the regulatory intent to support and validate rural generalist practice. Incorrect Approaches Analysis: Pursuing the assessment solely because it is a recognized credential without verifying specific eligibility or purpose is an incorrect approach. This fails to acknowledge that competency assessments are targeted and may not be universally applicable or beneficial to all physicians. It risks engaging in a process that is not aligned with the physician’s current practice needs or the assessment’s design, potentially leading to a mismatch in expectations and outcomes. Applying for the assessment based on a general understanding of “rural medicine” without consulting the specific guidelines for this particular assessment is also an incorrect approach. Rural generalist medicine has distinct competencies, and this assessment is tailored to those. A generalized understanding may not encompass the specific criteria the assessment evaluates, leading to an inappropriate application. Seeking the assessment primarily to enhance a resume for unrelated career aspirations, such as urban-based specialist training, without meeting the core eligibility for rural generalist practice, represents a significant ethical and regulatory failure. The assessment’s purpose is to support and validate rural practice, not to serve as a generic stepping stone for other career paths. This misrepresents the intent of the assessment and the regulatory framework it operates within. Professional Reasoning: Professionals should adopt a proactive and diligent approach to understanding any competency assessment. This involves: 1) Identifying the specific assessment and its governing body. 2) Locating and meticulously reviewing all official documentation regarding the assessment’s purpose, scope, and eligibility criteria. 3) Honestly evaluating one’s own practice setting, patient population, and career goals against these criteria. 4) Consulting with relevant professional organizations or regulatory bodies if any ambiguities exist. This systematic process ensures that professional development efforts are well-aligned, efficient, and compliant with the intended regulatory and ethical standards.

This scenario presents a professional challenge due to the inherent tension between a patient’s autonomy and the clinician’s duty of care, particularly in a rural setting where resources may be limited and the patient-physician relationship is often long-standing and deeply personal. The physician must navigate the patient’s expressed wishes, which may be influenced by various factors, against the medical necessity of a particular intervention and the potential for harm if that intervention is refused. Careful judgment is required to ensure the patient’s rights are respected while upholding ethical and professional standards. The best professional practice involves a comprehensive and empathetic approach that prioritizes informed consent and shared decision-making. This entails thoroughly explaining the diagnosis, the proposed treatment options (including the risks, benefits, and alternatives), and the potential consequences of refusing treatment, all in language the patient can understand. It requires actively listening to the patient’s concerns, values, and beliefs, and exploring the underlying reasons for their refusal. The physician should document this entire process meticulously, including the patient’s understanding and their voluntary decision. This approach aligns with the ethical principles of autonomy, beneficence, and non-maleficence, and is supported by professional guidelines emphasizing patient-centered care and informed consent. An incorrect approach would be to dismiss the patient’s concerns or to pressure them into accepting a treatment they are unwilling to undergo. This disregards the principle of patient autonomy and can lead to a breakdown of trust. Ethically, it constitutes a failure to obtain valid informed consent. Another incorrect approach would be to proceed with the treatment without adequately addressing the patient’s reservations or ensuring their full understanding. This violates the principle of informed consent and could be construed as battery, as treatment would be administered without valid permission. It also fails to uphold the physician’s duty to act in the patient’s best interest by not exploring all avenues to achieve patient buy-in or find mutually agreeable alternatives. A further incorrect approach would be to unilaterally decide that the patient lacks capacity and to proceed with treatment based on that assumption without a formal capacity assessment. This infringes upon the patient’s rights and can lead to significant ethical and legal repercussions. The presumption is always that an adult has capacity unless proven otherwise through a structured assessment process. Professionals should employ a decision-making framework that begins with establishing rapport and trust. This is followed by a thorough assessment of the clinical situation and the patient’s understanding. Open communication, active listening, and a non-judgmental attitude are crucial. When faced with patient refusal, the physician must explore the reasons, provide clear and understandable information, and offer alternatives. If capacity is in question, a formal assessment process must be initiated. Throughout this process, meticulous documentation is essential to protect both the patient and the clinician.

Scenario Analysis: This scenario is professionally challenging because it requires the rural generalist physician to integrate complex, evolving biomedical knowledge with the practical realities of patient care in a resource-limited setting. The physician must balance the need for evidence-based practice with the potential for diagnostic uncertainty and the ethical imperative to provide the best possible care, even when definitive diagnostic tools or specialist consultations are not immediately available. This necessitates a robust understanding of foundational sciences to inform clinical decision-making under pressure. Correct Approach Analysis: The best professional practice involves a systematic approach that begins with a thorough clinical assessment, leveraging foundational biomedical principles to formulate a differential diagnosis. This includes considering the pathophysiology of potential conditions, understanding relevant anatomical structures, and recalling the pharmacological mechanisms of action for potential treatments. The physician then uses this knowledge to guide targeted investigations, prioritizing those that are most likely to yield clinically significant information given the patient’s presentation and the available resources. This approach ensures that diagnostic and therapeutic decisions are grounded in scientific understanding and are tailored to the individual patient’s needs and the local context. This aligns with the ethical duty of beneficence and non-maleficence, ensuring that care is both effective and safe. Incorrect Approaches Analysis: One incorrect approach involves immediately resorting to broad-spectrum empirical treatment without a clear, evidence-based rationale derived from the patient’s specific presentation and foundational biomedical understanding. This risks inappropriate antibiotic use, masking of symptoms, and potential adverse drug reactions, failing to adhere to the principle of judicious resource utilization and potentially causing harm. Another incorrect approach is to delay definitive management due to the absence of advanced diagnostic technology, even when a strong clinical suspicion exists based on fundamental biomedical knowledge. This can lead to patient deterioration and missed opportunities for timely intervention, violating the duty to act in the patient’s best interest. A third incorrect approach is to rely solely on anecdotal experience or outdated guidelines without critically evaluating them against current biomedical understanding and the patient’s unique clinical picture. This can perpetuate suboptimal care and fail to incorporate advancements in medical science, compromising the quality of care provided. Professional Reasoning: Professionals should employ a structured diagnostic and management framework. This involves: 1. Comprehensive history and physical examination to gather initial data. 2. Application of foundational biomedical sciences (physiology, pathology, pharmacology, anatomy) to generate a prioritized differential diagnosis. 3. Judicious selection of investigations, considering their diagnostic yield, cost, and availability. 4. Evidence-based treatment planning, adapting to local resources and patient factors. 5. Continuous reassessment and learning to integrate new knowledge and refine clinical practice.

Scenario Analysis: This scenario presents a common challenge in rural generalist medicine: managing diagnostic uncertainty with limited immediate access to specialist imaging interpretation. The rural generalist physician must balance the need for timely diagnosis and appropriate patient care with resource limitations and the potential for delayed specialist input. This requires a robust understanding of diagnostic reasoning, appropriate imaging selection based on clinical suspicion and local availability, and a clear workflow for interpretation and follow-up, all within the ethical and professional standards of Canadian medical practice. Correct Approach Analysis: The best professional practice involves a systematic approach that prioritizes patient safety and evidence-based medicine. This includes a thorough clinical assessment to formulate a differential diagnosis, followed by the selection of the most appropriate imaging modality based on the suspected pathology and its diagnostic yield. Crucially, the physician must then have a clear, pre-established protocol for obtaining a timely interpretation, whether through local radiologist availability, teleradiology services, or a defined pathway for urgent consultation with a remote specialist. This ensures that diagnostic information is obtained and acted upon efficiently, minimizing delays in patient management and adhering to the principles of good medical practice and patient-centered care as outlined by the College of Physicians and Surgeons of Alberta (CPSA) guidelines on professional conduct and medical imaging. Incorrect Approaches Analysis: One incorrect approach involves ordering advanced imaging without a clear clinical indication or a defined plan for immediate interpretation, especially if local resources are scarce. This can lead to unnecessary patient exposure to radiation, increased healthcare costs, and significant delays in diagnosis and treatment if interpretation is not promptly available. Ethically, this deviates from the principle of beneficence and non-maleficence by potentially causing harm through delay or unnecessary procedures. Another unacceptable approach is to rely solely on the patient’s subjective report of symptoms without pursuing objective diagnostic measures when indicated, or conversely, to order a broad range of imaging tests indiscriminately without a focused differential diagnosis. This lacks the systematic diagnostic reasoning required for efficient and effective patient care and may not align with the CPSA’s expectations for evidence-based practice and prudent resource utilization. A further flawed approach would be to delay definitive management based on imaging findings without seeking timely specialist input when the findings are ambiguous or require expert interpretation beyond the generalist’s scope. This could compromise patient outcomes and falls short of the professional obligation to ensure patients receive appropriate care, potentially violating the CPSA’s standards for consultation and referral. Professional Reasoning: Professionals should employ a structured diagnostic reasoning process: gather comprehensive patient history and perform a thorough physical examination, develop a prioritized differential diagnosis, select the most appropriate diagnostic tests (including imaging) based on clinical suspicion, local availability, and cost-effectiveness, and establish a clear plan for interpretation and follow-up, including timely specialist consultation when necessary. This iterative process ensures that diagnostic efforts are focused, efficient, and ultimately serve the best interests of the patient, adhering to ethical obligations and professional standards.

Scenario Analysis: This scenario is professionally challenging because it requires a rural generalist physician to balance immediate patient care needs with broader population health goals, specifically addressing health inequities within a vulnerable demographic. The physician must navigate limited resources, potential community distrust, and the complex interplay of social determinants of health. Careful judgment is required to ensure that interventions are both clinically effective and ethically sound, promoting equitable access and outcomes. Correct Approach Analysis: The best professional approach involves collaborating with community leaders and public health officials to understand the specific barriers to health equity faced by the Indigenous population. This approach is correct because it directly addresses the root causes of health disparities by engaging the affected community in identifying solutions. It aligns with ethical principles of justice and beneficence, ensuring that interventions are culturally appropriate and responsive to community needs. Furthermore, it leverages the expertise of public health professionals to inform evidence-based strategies for population health improvement, respecting the principles of community-based participatory research and Indigenous self-determination in health. Incorrect Approaches Analysis: Focusing solely on individual patient care without considering the underlying systemic issues perpetuates health inequities. This approach fails to address the social determinants of health that disproportionately affect the Indigenous population, such as access to culturally safe healthcare, education, and economic opportunities. It is ethically problematic as it does not actively work towards justice or the reduction of health disparities. Implementing a top-down, one-size-fits-all health program designed by external experts without community input is likely to be ineffective and may even be culturally insensitive. This approach disregards the unique context and lived experiences of the Indigenous community, violating principles of respect for autonomy and cultural humility. It risks alienating the community and undermining trust, hindering future health initiatives. Relying exclusively on data collection and analysis without translating findings into actionable community-led interventions misses the opportunity to create meaningful change. While data is crucial for understanding the scope of the problem, it becomes a missed ethical obligation if not used to inform and empower the community to address their own health challenges. This approach can lead to a passive understanding of inequity rather than active efforts to dismantle it. Professional Reasoning: Professionals facing such a scenario should employ a decision-making framework that prioritizes community engagement and partnership. This involves: 1. Understanding the local context: Actively seeking to comprehend the specific social, economic, and cultural factors influencing the health of the rural Indigenous population. 2. Collaborative problem-solving: Engaging community members, elders, and local organizations as equal partners in identifying health priorities and developing solutions. 3. Leveraging expertise: Integrating clinical knowledge with public health insights and community wisdom to design culturally relevant and sustainable interventions. 4. Ethical reflection: Continuously evaluating interventions against principles of justice, beneficence, non-maleficence, and respect for autonomy, with a particular focus on equity. 5. Advocacy: Recognizing the role of the generalist physician as an advocate for their patients and community, addressing systemic barriers to health.

Scenario Analysis: This scenario presents a professional challenge rooted in the inherent tension between patient autonomy and the clinician’s duty of care, particularly in a rural generalist setting where resources and immediate specialist support may be limited. The physician must balance respecting the patient’s informed decision-making with ensuring their safety and well-being, while also considering the practicalities of follow-up and potential complications in a remote location. This requires a nuanced understanding of ethical principles and professional responsibilities. Correct Approach Analysis: The best approach involves a thorough, documented discussion with the patient regarding the risks and benefits of their chosen course of action, exploring the underlying reasons for their decision, and collaboratively developing a safety net plan. This aligns with the ethical principle of respect for autonomy, which mandates that competent individuals have the right to make decisions about their own healthcare, even if those decisions seem suboptimal to the clinician. It also upholds the professional duty to ensure informed consent, which requires not just providing information but also confirming the patient’s understanding and capacity to decide. Documenting this process is crucial for professional accountability and to demonstrate that all reasonable steps were taken to ensure patient safety within the bounds of their autonomy. This approach also reflects the principles of shared decision-making, fostering a collaborative relationship between physician and patient. Incorrect Approaches Analysis: One incorrect approach involves overriding the patient’s wishes and proceeding with a treatment they have refused. This directly violates the principle of patient autonomy and informed consent, potentially leading to a breach of professional ethics and legal repercussions. It assumes the physician’s judgment is inherently superior to the patient’s, disregarding their right to self-determination. Another incorrect approach is to simply document the patient’s refusal without further exploration or attempts to mitigate risks. This fails to uphold the duty of care, as it neglects the physician’s responsibility to ensure the patient understands the potential consequences of their decision and to explore all reasonable alternatives or safety measures. It represents a passive approach that could lead to preventable harm. A third incorrect approach is to dismiss the patient’s concerns and proceed with the treatment they desire without adequately addressing their underlying reasons or ensuring they fully comprehend the implications of their choice. This also undermines informed consent and patient autonomy, as it prioritizes the physician’s agenda over the patient’s understanding and right to refuse or accept treatment based on their own values and circumstances. Professional Reasoning: Professionals should employ a decision-making framework that prioritizes ethical principles, particularly autonomy and beneficence, alongside professional duties. This involves active listening, empathetic communication, thorough risk-benefit analysis, and collaborative problem-solving. When faced with a patient’s decision that conflicts with the physician’s recommendation, the process should involve: 1) ensuring the patient has capacity and is fully informed; 2) exploring the patient’s rationale and values; 3) clearly articulating the risks and benefits of all options, including the patient’s preferred course; 4) collaboratively developing a plan that maximizes safety and respects autonomy, including a robust safety net; and 5) meticulously documenting the entire process.