What is the recommended approach when a patient requests discontinuation of life-sustaining therapy against medical advice?

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Respecting patient autonomy while ensuring informed decision making is essential when a patient requests discontinuation of life-sustaining therapy. Start by exploring the patient’s goals and values to understand what matters most to them and to uncover any misconceptions or fears. Provide clear information about prognosis with and without continued treatment, and discuss realistic alternatives such as comfort-focused care, palliative care, or hospice. Involve an ethics consult or palliative care team if there are conflicts, uncertainties, or questions about capacity or the appropriateness of the request. Document the decision thoroughly in the medical record, including the patient’s capacity, the information provided, the specific decisions made, and the agreed plan for support and symptom management. Ensure ongoing support for the patient and family, including spiritual, psychosocial, and caregiver resources. If the patient lacks capacity, involve an appropriate surrogate decision-maker according to policy and advance directives.