Scenario Analysis: This scenario presents a common challenge in advanced heart failure and transplant cardiology: balancing the imperative for continuous quality improvement and patient safety with the practicalities of data collection, analysis, and implementation of changes within a busy clinical environment. The pressure to demonstrate outcomes, adhere to evolving guidelines, and ensure equitable patient care while managing limited resources requires careful, evidence-based decision-making. The professional challenge lies in selecting the most effective and ethically sound strategy for refining practice based on observed outcomes. Correct Approach Analysis: The best professional approach involves a systematic, multi-faceted strategy that begins with a thorough retrospective analysis of existing patient data to identify specific areas of suboptimal outcomes or potential safety concerns. This analysis should then inform the development of targeted quality improvement initiatives, such as refining patient selection criteria, optimizing peri-operative protocols, or enhancing post-transplant surveillance. Crucially, these initiatives must be guided by established best practices and regulatory requirements for organ transplantation and patient care, ensuring that any proposed changes are evidence-based and aligned with ethical principles of beneficence and non-maleficence. The process should include prospective data collection to monitor the impact of these changes and facilitate further iterative refinement, fostering a culture of continuous learning and data-driven practice improvement. This aligns with the ethical obligation to provide the highest standard of care and the regulatory expectation for robust quality management systems in transplant centers. Incorrect Approaches Analysis: Implementing changes based solely on anecdotal evidence or individual clinician experience, without rigorous data analysis, represents a significant ethical and regulatory failure. Such an approach risks introducing interventions that are not evidence-based, potentially leading to unintended harm to patients or a decline in overall outcomes. It bypasses the systematic review required to identify true drivers of suboptimal performance and may lead to the misallocation of resources. Adopting a reactive approach that only addresses issues after adverse events have occurred is also professionally unacceptable. While event review is important, a proactive and data-driven quality improvement framework aims to prevent adverse events by identifying and mitigating risks before they manifest. Relying solely on reactive measures fails to meet the ethical standard of diligent patient care and the regulatory expectation for a robust patient safety program. Focusing exclusively on external benchmarks or competitor performance without a deep understanding of the center’s own data and specific patient population is another flawed strategy. While benchmarking can provide valuable context, it should not replace internal analysis. Without understanding the root causes of performance within one’s own system, external comparisons may lead to the adoption of inappropriate interventions or a failure to address unique local challenges, thereby compromising patient safety and quality of care. Professional Reasoning: Professionals in advanced heart failure and transplant cardiology should employ a structured decision-making process that prioritizes evidence-based practice and patient safety. This involves: 1) establishing clear quality metrics and patient safety goals aligned with regulatory requirements and ethical principles; 2) systematically collecting and analyzing relevant patient data to identify trends, deviations, and areas for improvement; 3) developing targeted, evidence-based interventions to address identified issues; 4) implementing these interventions with appropriate oversight and monitoring; and 5) continuously evaluating the impact of these interventions on patient outcomes and safety, using the data to inform further refinements. This iterative, data-driven cycle ensures that practice evolves in a manner that maximizes patient benefit and minimizes risk, adhering to the highest professional and regulatory standards.

Scenario Analysis: This scenario is professionally challenging because it requires a nuanced understanding of the specific eligibility criteria for advanced training in heart failure and transplant cardiology within the Latin American context. Misinterpreting or misapplying these criteria can lead to inappropriate candidate selection, potentially impacting the quality of specialized care and the integrity of the training program. Careful judgment is required to ensure that only those who meet the defined standards are considered, thereby upholding the competency assessment’s purpose. Correct Approach Analysis: The best professional practice involves a thorough review of the candidate’s existing qualifications against the explicitly stated purpose and eligibility requirements of the Latin American Advanced Heart Failure and Transplant Cardiology Competency Assessment. This includes verifying prior training, clinical experience in cardiology, and any specific prerequisites outlined by the governing body for this advanced assessment. Adherence to these defined criteria ensures that the assessment serves its intended function of identifying individuals with the necessary foundational knowledge and skills to undertake advanced training, thereby upholding the program’s standards and the ethical imperative to provide competent specialized care. Incorrect Approaches Analysis: One incorrect approach involves prioritizing a candidate’s general enthusiasm for transplant cardiology over documented eligibility. While passion is valuable, it does not substitute for the specific academic and clinical prerequisites mandated by the competency assessment framework. This approach fails to adhere to the regulatory intent of the assessment, which is to evaluate established competencies, not potential based solely on interest. Another incorrect approach is to assume that a broad cardiology fellowship automatically confers eligibility for advanced heart failure and transplant training without specific verification against the assessment’s criteria. The advanced assessment is designed to evaluate specialized knowledge and skills beyond general cardiology, and assuming equivalence without explicit confirmation is a regulatory oversight. A further incorrect approach is to consider only the candidate’s current institutional role as a determinant of eligibility. While a senior position might suggest experience, it does not guarantee that the candidate has met the specific, often detailed, requirements for advanced training in heart failure and transplant cardiology as defined by the Latin American framework. This overlooks the precise nature of the competency assessment. Professional Reasoning: Professionals should approach candidate evaluation for specialized competency assessments by first meticulously understanding the stated purpose and eligibility criteria of the assessment itself. This involves consulting the official documentation, guidelines, and regulatory frameworks governing the assessment. A systematic comparison of the candidate’s documented qualifications against these specific requirements should then be performed. Any deviations or ambiguities should be clarified through official channels or by seeking expert guidance within the relevant professional bodies. The decision-making process must be grounded in objective evidence of meeting defined standards, ensuring fairness, transparency, and the integrity of the advanced training pathway.

Scenario Analysis: This scenario presents a professional challenge due to the inherent complexities of managing advanced heart failure patients, particularly concerning the ethical and regulatory considerations surrounding organ transplantation. Balancing the immediate needs of the patient with the long-term viability of the organ donor pool and adhering to strict allocation criteria requires meticulous judgment and a deep understanding of established protocols. The pressure to act quickly while ensuring fairness and adherence to guidelines is paramount. Correct Approach Analysis: The best professional practice involves a comprehensive and transparent assessment of the patient’s candidacy for heart transplantation, strictly adhering to the established national organ allocation guidelines. This approach prioritizes objective medical criteria, patient suitability, and equitable distribution of scarce resources. It ensures that all potential recipients are evaluated against the same rigorous standards, minimizing bias and maximizing the chances of successful transplantation and long-term patient survival. This aligns with the ethical principles of justice and beneficence, as well as regulatory mandates for fair organ allocation. Incorrect Approaches Analysis: One incorrect approach involves prioritizing the patient based on perceived social worth or the urgency of their condition without a formal, guideline-driven assessment. This fails to uphold the principle of justice by potentially disadvantaging other equally or more deserving candidates who may not have the same level of advocacy or perceived social importance. It also bypasses the established regulatory framework for organ allocation, which is designed to ensure fairness and prevent arbitrary decision-making. Another unacceptable approach is to delay the formal evaluation process due to concerns about the patient’s lifestyle choices or perceived non-compliance, without first conducting a thorough assessment of their current medical status and potential for rehabilitation. While adherence to medical advice is important, excluding a patient from consideration based on assumptions rather than objective evaluation and a clear pathway for addressing concerns is ethically problematic and may violate regulatory requirements for comprehensive patient assessment. A further incorrect approach is to focus solely on the immediate medical urgency without considering the long-term prognosis and the patient’s ability to benefit from a transplant and adhere to post-transplant care. This can lead to the allocation of a scarce organ to a patient who may not achieve the best long-term outcome, thereby not maximizing the benefit to the donor pool and potentially compromising the success of the transplant. It neglects the holistic assessment required by ethical guidelines and regulatory frameworks. Professional Reasoning: Professionals should employ a structured decision-making process that begins with a thorough understanding of the relevant national organ allocation guidelines and ethical principles. This involves objective patient assessment against established criteria, transparent communication with the patient and their family, and collaboration with the multidisciplinary transplant team. When faced with complex cases, seeking consultation with ethics committees or senior colleagues experienced in transplant coordination is crucial to ensure adherence to best practices and regulatory compliance.

The control framework reveals a scenario demanding careful diagnostic reasoning and imaging selection in advanced heart failure, a situation professionally challenging due to the complexity of patient presentations, the rapid evolution of diagnostic technologies, and the critical need for timely and accurate interventions to optimize patient outcomes and resource allocation. Misinterpretation or suboptimal imaging choices can lead to delayed treatment, inappropriate therapies, or unnecessary procedures, impacting both patient well-being and healthcare system efficiency. The best approach involves a systematic, evidence-based workflow that prioritizes non-invasive imaging modalities for initial assessment and risk stratification, reserving more invasive or resource-intensive investigations for specific clinical indications or when non-invasive methods are inconclusive. This aligns with ethical principles of beneficence and non-maleficence by ensuring that diagnostic efforts are proportionate to the clinical question and patient risk, and with regulatory guidelines that emphasize cost-effectiveness and patient safety. Specifically, initiating with echocardiography to assess global and regional systolic and diastolic function, valvular integrity, and chamber dimensions, followed by cardiac magnetic resonance imaging (CMR) for detailed tissue characterization (e.g., fibrosis, infiltration) and volumetric assessment when indicated, represents a robust, tiered strategy. This sequence minimizes patient exposure to radiation and contrast agents where possible, while maximizing diagnostic yield. An approach that immediately opts for invasive procedures like endomyocardial biopsy without prior non-invasive assessment fails to adhere to the principle of least harm and may expose the patient to unnecessary procedural risks. This bypasses established diagnostic pathways and lacks regulatory justification for its invasiveness. Similarly, relying solely on a single imaging modality without considering its limitations or the specific clinical context, such as exclusively using computed tomography (CT) for all advanced heart failure evaluations, can lead to incomplete or misleading information. CT is often less sensitive for functional assessment and tissue characterization compared to echocardiography and CMR, and its use without clear indication may not be cost-effective or ethically justifiable. An approach that prioritizes advanced imaging techniques without a clear diagnostic question or a stepwise progression based on initial findings can also be problematic, leading to over-investigation and potential misinterpretation of incidental findings. Professionals should employ a decision-making framework that begins with a thorough clinical assessment, including history, physical examination, and basic laboratory tests. This should guide the selection of appropriate diagnostic imaging, starting with less invasive and more readily available modalities. The interpretation of imaging findings must be integrated with the clinical picture, and further investigations should be pursued only when necessary to answer specific clinical questions or to refine management strategies, always considering the risks, benefits, and cost-effectiveness of each step.

This scenario presents a common challenge in advanced heart failure management: balancing aggressive treatment with patient-centered goals and resource allocation. The professional challenge lies in synthesizing complex clinical data, prognostic indicators, and patient preferences to formulate an evidence-based, yet individualized, care plan. This requires not only deep medical knowledge but also strong communication skills and an understanding of ethical considerations, particularly concerning the appropriate use of advanced therapies and the potential for futility. The best approach involves a comprehensive, multidisciplinary assessment that prioritizes shared decision-making. This includes a thorough evaluation of the patient’s current clinical status, comorbidities, functional capacity, and psychosocial factors. Crucially, it necessitates an open and honest discussion with the patient and their family about prognosis, treatment options (including mechanical circulatory support and transplantation), potential benefits, risks, and alternatives, such as palliative care. This aligns with ethical principles of autonomy and beneficence, ensuring that treatment decisions are aligned with the patient’s values and goals of care. Regulatory frameworks in advanced heart failure management emphasize the importance of patient-centered care and the judicious application of advanced therapies, requiring a robust assessment process before proceeding to interventions like transplantation. An incorrect approach would be to solely focus on listing potential advanced therapies without a thorough assessment of the patient’s suitability or their expressed wishes. This fails to uphold the principle of beneficence, as it may lead to interventions that offer little to no meaningful benefit and carry significant risks. It also neglects the ethical imperative of respecting patient autonomy by not engaging in shared decision-making. Another incorrect approach is to prematurely dismiss advanced therapies based on a single clinical parameter or a generalized assumption about patient eligibility, without a comprehensive evaluation. This can lead to suboptimal care and potentially deny patients access to life-extending treatments for which they might be suitable. It demonstrates a lack of adherence to evidence-based guidelines that advocate for individualized assessment. Finally, an approach that prioritizes the availability of organs or institutional protocols over the individual patient’s clinical condition and preferences is ethically unsound. This shifts the focus away from patient well-being and can lead to inappropriate allocation of scarce resources, violating principles of justice and fairness in healthcare. Professionals should adopt a systematic decision-making process that begins with a thorough clinical and psychosocial assessment. This should be followed by an in-depth discussion with the patient and family, exploring their understanding of the disease, their goals, and their values. Evidence-based guidelines for advanced heart failure management should then be applied to inform the discussion of all available treatment options, including medical management, mechanical circulatory support, and transplantation. The final decision should be a shared one, reflecting the patient’s informed consent and the multidisciplinary team’s clinical judgment.

Scenario Analysis: This scenario is professionally challenging because it requires balancing the need for consistent and fair assessment of competency with the practical realities of candidate performance and the potential for individual circumstances to impact outcomes. Determining appropriate blueprint weighting, scoring, and retake policies necessitates a deep understanding of the assessment’s purpose, the ethical obligations to both candidates and the public, and the regulatory framework governing professional competency evaluations. Misjudgments can lead to either overly lenient assessments that compromise patient safety or overly stringent policies that unfairly penalize capable individuals. Correct Approach Analysis: The best approach involves a comprehensive review of the assessment’s blueprint, ensuring that the weighting of topics accurately reflects their importance in advanced heart failure and transplant cardiology practice, as determined by expert consensus and current clinical guidelines. Scoring should be criterion-referenced, meaning it establishes clear benchmarks for demonstrating mastery of essential knowledge and skills, rather than being norm-referenced (comparing candidates to each other). Retake policies should be clearly defined, transparent, and allow for remediation and re-assessment, acknowledging that initial performance may not always be indicative of ultimate competency, while still upholding standards. This approach aligns with ethical principles of fairness, validity, and reliability in assessment, ensuring that only those who meet established standards are certified. It also adheres to the spirit of professional development, allowing for growth and improvement. Incorrect Approaches Analysis: One incorrect approach would be to solely rely on historical scoring data without re-evaluating the blueprint’s relevance to contemporary practice. This fails to ensure that the assessment remains current and accurately reflects the evolving demands of advanced heart failure and transplant cardiology, potentially leading to outdated competency evaluations. Another incorrect approach would be to implement a strict “one-strike” retake policy with no opportunity for remediation or further training. This is ethically problematic as it does not account for individual learning curves or extenuating circumstances that might affect a candidate’s performance on a single attempt, potentially barring competent individuals from practice. A third incorrect approach would be to arbitrarily adjust scoring thresholds based on the overall pass rate of a particular cohort. This undermines the criterion-referenced nature of the assessment, introducing subjectivity and compromising the integrity of the competency standards. It shifts the focus from demonstrating mastery to achieving a predetermined statistical outcome, which is not aligned with professional assessment principles. Professional Reasoning: Professionals should approach the development and refinement of competency assessments by prioritizing validity, reliability, fairness, and transparency. This involves a cyclical process of blueprint review, item development, scoring calibration, and policy establishment, all informed by expert input and relevant professional standards. When considering retake policies, the focus should be on supporting candidate development while safeguarding public safety. A robust decision-making framework would involve forming a committee of subject matter experts to review the assessment’s components, conduct pilot testing, analyze performance data, and propose revisions that are then subject to a formal approval process, ensuring that all decisions are evidence-based and ethically sound.

This scenario is professionally challenging because it requires a candidate to balance the need for comprehensive preparation with the practical constraints of time and available resources, all while adhering to the rigorous standards expected in advanced heart failure and transplant cardiology. The pressure to perform well on a competency assessment, which directly impacts their ability to practice, necessitates a strategic and informed approach to preparation. Careful judgment is required to select resources and allocate time effectively without compromising the depth of understanding or succumbing to information overload. The best approach involves a structured, multi-modal preparation strategy that prioritizes official guidelines and expert consensus documents, supplemented by targeted review of recent literature and case-based learning. This method is correct because it directly aligns with the core competencies assessed in advanced cardiology training. Regulatory frameworks and professional guidelines for such assessments typically emphasize mastery of established knowledge bases and the ability to apply them to clinical scenarios. Utilizing resources like the latest guidelines from relevant professional societies (e.g., ISHLT, AHA/ACC) and reputable textbooks provides a foundational understanding. Incorporating peer-reviewed journals for updates and engaging in case discussions or simulation exercises ensures practical application and critical thinking, which are essential for demonstrating competency. This comprehensive yet focused strategy ensures that the candidate is well-prepared across all assessed domains, reflecting a commitment to patient safety and evidence-based practice, which are paramount ethical and regulatory considerations. An approach that relies solely on a single textbook, even a comprehensive one, is professionally unacceptable. While textbooks provide a solid foundation, they may not always reflect the most current evidence or nuanced clinical approaches that are critical for advanced practice. This can lead to a gap between theoretical knowledge and practical application, potentially failing to meet the dynamic standards of the field. Another professionally unacceptable approach is to focus exclusively on memorizing facts and figures without engaging in critical analysis or application. Competency assessments in advanced cardiology are designed to evaluate a candidate’s ability to think critically, solve complex problems, and make sound clinical judgments, not merely recall information. This method fails to develop the higher-order cognitive skills necessary for managing complex heart failure and transplant patients. Finally, an approach that involves passively reviewing lecture slides without active engagement or seeking clarification is also professionally deficient. While lectures can be informative, passive learning often leads to superficial understanding. The complexity of advanced heart failure and transplant cardiology demands active learning, critical appraisal of information, and the ability to integrate knowledge from various sources, which passive review does not facilitate. Professionals should adopt a decision-making framework that begins with understanding the scope and objectives of the competency assessment. This involves identifying the key knowledge domains and skill sets that will be evaluated. Subsequently, they should research and select a diverse range of high-quality preparation resources, prioritizing those that are evidence-based and endorsed by leading professional organizations. A realistic study timeline should then be developed, incorporating regular review, practice questions, and opportunities for case-based learning and discussion. Finally, continuous self-assessment and seeking feedback are crucial to identify areas needing further attention, ensuring a well-rounded and effective preparation strategy.

Scenario Analysis: This scenario presents a professional challenge due to the inherent complexity of advanced heart failure management, particularly when considering the integration of foundational biomedical sciences with clinical decision-making. The physician must navigate the nuances of patient-specific pathophysiology, the evolving landscape of therapeutic options, and the ethical considerations surrounding treatment intensity and patient autonomy. Careful judgment is required to balance aggressive interventions with the patient’s quality of life and prognosis, ensuring that all decisions are evidence-based and patient-centered. Correct Approach Analysis: The best professional practice involves a comprehensive assessment that integrates the patient’s detailed clinical presentation, including symptoms, functional status, and comorbidities, with a thorough understanding of the underlying pathophysiological mechanisms of their advanced heart failure. This includes evaluating cardiac structure and function through advanced imaging, assessing hemodynamic profiles, and considering genetic predispositions or specific molecular pathways contributing to the disease. This approach is correct because it aligns with the principles of evidence-based medicine and patient-centered care, ensuring that treatment strategies are tailored to the individual’s unique biological and clinical context. It also implicitly adheres to ethical guidelines that mandate informed consent and shared decision-making, where the physician’s deep understanding of the science informs the patient’s choices. Incorrect Approaches Analysis: One incorrect approach would be to solely rely on established clinical guidelines for heart failure management without a deep dive into the patient’s specific biomedical underpinnings. While guidelines are essential, they may not capture the full spectrum of an individual’s complex disease process or account for novel scientific insights that could offer alternative or superior treatment pathways. This approach fails to leverage the full potential of integrated biomedical science, potentially leading to suboptimal or even inappropriate treatment selection. Another incorrect approach would be to prioritize experimental or novel therapies based on preliminary research findings without robust clinical validation or a clear understanding of their specific application to the patient’s condition. This could lead to exposing the patient to unproven risks without commensurate benefits, violating the ethical principle of non-maleficence and potentially contravening regulatory requirements for the use of investigational treatments. A further incorrect approach would be to focus exclusively on the patient’s subjective experience of symptoms without adequately investigating the objective biomedical drivers of their advanced heart failure. While symptom management is crucial, neglecting the underlying pathophysiology can lead to a failure to address the root cause of the patient’s decline, resulting in a lack of effective long-term management and potentially overlooking treatable conditions. Professional Reasoning: Professionals should adopt a systematic approach that begins with a comprehensive patient evaluation, encompassing both clinical history and physical examination. This should be followed by a detailed review of diagnostic data, including advanced imaging, laboratory tests, and potentially genetic or molecular profiling, to elucidate the specific pathophysiological mechanisms at play. The physician must then critically appraise the available evidence for various therapeutic interventions, considering their efficacy, safety, and applicability to the patient’s unique profile. Finally, all treatment decisions must be made in collaboration with the patient and their family, ensuring informed consent and alignment with their values and goals of care.

This scenario presents a professional challenge rooted in the inherent tension between patient autonomy, the physician’s duty of care, and the complexities of advanced medical interventions like heart transplantation. The patient’s advanced heart failure and the potential for a life-saving transplant necessitate careful consideration of their capacity to understand the risks, benefits, and alternatives, especially when the patient expresses a desire to avoid further treatment. The physician must navigate this delicate balance, ensuring that any decision is informed, voluntary, and aligns with ethical and professional standards. The best approach involves a comprehensive assessment of the patient’s decision-making capacity, focusing on their ability to understand the information provided, appreciate the consequences of their choices, and communicate their decision. This includes a thorough discussion of their current condition, the prognosis with and without transplantation, the transplant process itself, and the implications of refusing further treatment. If the patient demonstrates capacity, their wishes must be respected, even if they differ from the physician’s recommendation. This aligns with the fundamental ethical principles of autonomy and beneficence, as well as professional guidelines that emphasize shared decision-making and respect for patient values. An approach that immediately proceeds with transplant evaluation without a formal capacity assessment, despite the patient’s expressed reluctance, fails to uphold the principle of patient autonomy. It risks overriding a potentially informed decision and could lead to a procedure the patient does not truly desire, violating their right to self-determination. Another unacceptable approach is to dismiss the patient’s concerns as a temporary emotional response and proceed with aggressive treatment recommendations without adequately exploring the underlying reasons for their reluctance. This paternalistic stance disregards the patient’s lived experience and their right to make choices about their own body and future, potentially leading to a breach of trust and ethical misconduct. Finally, an approach that involves pressuring the patient to accept the transplant by emphasizing only the positive outcomes and downplaying the risks and burdens is ethically unsound. This manipulative tactic undermines the informed consent process and violates the principle of honesty and transparency, which are cornerstones of the physician-patient relationship. Professionals should employ a structured decision-making process that begins with establishing rapport and open communication. This involves active listening to understand the patient’s perspective, followed by a clear and comprehensive explanation of their medical situation and treatment options. A formal capacity assessment should be conducted if there is any doubt about the patient’s ability to make informed decisions. Respecting patient values and preferences, even when they challenge medical recommendations, is paramount. When capacity is present, shared decision-making should be the guiding principle, ensuring the patient is an active participant in their care.

The evaluation methodology shows that assessing complex ethical dilemmas in advanced heart failure and transplant cardiology requires a nuanced understanding of patient autonomy, beneficence, and the principles of health systems science. This scenario is professionally challenging because it pits the physician’s desire to offer a potentially life-saving treatment against the patient’s current capacity to understand and consent to a complex, high-risk procedure, while also considering the broader implications for resource allocation within the health system. Careful judgment is required to balance these competing ethical and practical considerations. The best approach involves a structured, multi-faceted assessment of the patient’s decision-making capacity, involving a multidisciplinary team and exploring all available alternatives, including palliative care, before proceeding with any discussion of transplant. This approach prioritizes patient autonomy by ensuring that any consent is truly informed and voluntary, aligns with the principle of beneficence by acting in the patient’s best interest, and demonstrates responsible health systems science by considering the appropriate use of scarce resources. It acknowledges that capacity can fluctuate and requires ongoing evaluation. An approach that immediately proceeds with transplant evaluation without a thorough assessment of decision-making capacity fails to uphold the principle of informed consent, potentially leading to a patient undergoing a procedure they do not fully comprehend or desire. This disregards patient autonomy and could result in significant harm. Another unacceptable approach is to unilaterally decide that the patient is not a candidate for transplant based on perceived capacity issues without involving a formal capacity assessment or multidisciplinary team. This paternalistic stance undermines patient autonomy and beneficence, as it removes the patient’s right to participate in decisions about their own care. Furthermore, an approach that focuses solely on the medical indications for transplant without adequately addressing the patient’s understanding, values, and the ethical implications of the procedure for both the patient and the healthcare system is incomplete. Health systems science mandates a broader perspective that includes resource stewardship and equitable access. Professionals should employ a decision-making framework that begins with a comprehensive assessment of the patient’s clinical status and potential for recovery. This should be followed by a thorough evaluation of decision-making capacity, involving relevant specialists if necessary. Open and honest communication with the patient and their family, exploring all treatment options and their associated risks and benefits, is paramount. The principles of shared decision-making should guide the process, ensuring that the patient’s values and preferences are central to the care plan. Finally, consideration of the broader health system implications, including resource allocation and the potential impact on other patients, should be integrated into the ethical deliberation.