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Many of these patients lack advance directives and healthcare proxies leaving clinicians with unclear guidance on subsequent treatment decisions and few existing mechanisms to address this issue. We present a case of a 55-year-old man with recurrent oral squamous cell carcinoma who lacked decision-making capacity due to cognitive impairment. He did not have an advance directive or documented healthcare proxy. He declined curative-intent cancer-directed therapy. The dilemma of treatment over objection was carefully explored and the patient ultimately underwent palliative radiation therapy. We advocate for a multidisciplinary framework in which all potential interventions both curative and palliative including treatment over objection are thoughtfully and carefully explored. We illustrate the need for improved guidance and approaches to ensure that these patients who lack decision-making capacity have access to potentially life-saving and therapeutic interventions.<\/jats:p>","DOI":"10.1177\/08258597251339870","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T04:34:04Z","timestamp":1748925244000},"page":"275-296","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Impaired Decision-Making Capacity in a Patient With Oral Squamous Cell Carcinoma: Weighing the Benefits and Harms of Treatment Against Objection"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-2110-862X","authenticated-orcid":false,"given":"Charley","family":"Jang","sequence":"first","affiliation":[{"name":"Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0385-9801","authenticated-orcid":false,"given":"Olivia M.","family":"Seecof","sequence":"additional","affiliation":[{"name":"Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA"},{"name":"Laura and Isaac Perlmutter Cancer Center, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette","family":"Georgia","sequence":"additional","affiliation":[{"name":"Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,6,3]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/JGP.0b013e3182436987"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-684X-12-1"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1023"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)17224-3"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp074045"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1159\/000509119"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/bsl.764"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181c67bce"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1002\/pon.5812"},{"issue":"2","key":"e_1_3_4_11_2","first-page":"249","article-title":"The limits of advance directives: a history and assessment of the Patient Self-Determination Act","volume":"32","author":"Larson EJ","year":"1997","unstructured":"Larson EJ, Eaton TA. 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