Recently, Zaldy Tan MD wrote a thoughtful article in JAMA ( The “Right” to Fall, JAMA. 2010;303(23):2333-2334 ) regarding the autonomy of elders and the tension we often face in the geripal world between doing right for the patient and preserving the rights of the patient. I’m sure many of us have experienced this and have repeatedly discussed in team and with families whether there is “anything we can do” to help the patient who is surely a slow-motion train wreck waiting to happen. Unlike Wall Street banks, we allow patients to decide to “fail” on a regular basis: she doesn’t want more help, doesn’t want to consider moving to a higher level of care, doesn’t want to have that test/procedure/ medication/(fill in the blank), and HAS capacity, however limited, to make her own decisions even when those decisions may result in injuries or hospitalizations. Dr. Tan writes of the impact the patient’s decisions have on her aging daughter and on the treatment teams and concludes that “I