Ethics and Professional Practicemiddle twist
A 42-year-old woman with recurrent bipolar disorder has made a written advance statement saying that she would want lithium during a future manic relapse. She is now mildly elevated in mood but attends voluntarily, understands the proposed treatment and its adverse effects, and refuses lithium after a supported discussion. Her psychiatrist considers the earlier statement clinically sensible. Which is the most appropriate course?