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The United States has a high incarceration rate. Incarceration is associated with increased risk for cancer, chronic illness, serious mental illness, and substance use disorder. People who are incarcerated are less likely to be offered or participate in advance care planning, less likely to document their treatment preferences, and might not have a surrogate if one is needed. This article explores medical decision making for patients who are incarcerated and unrepresented and considers advantages and disadvantages of different classes of decision makers for them.

Who Should Make Decisions for Unrepresented Patients Who Are Incarcerated?