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A systematic approach to autonomous decision making by patients as part of our standardized bum protocol ensures that our patients are given respect and a sense of control. This approach, which we believe to be ethically and legally sound, has no documented physiologic effect on our patients, but increases the self-determination they exercise and the communication they receive. The designation of a spokesperson to be consulted if the patient becomes unable to speak for himself prevents much anguish while retaining patient autonomy.
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