Medical decision-making can be complex especially when a caregiver is not the patient’s parent or the patient is a young adult with disability. Understanding the legal and nonlegal options available to caregivers and young adults helps ensure patient-centered care. Legal action such as guardianship clearly defines decision-making authority. Options such as state consenting statues, consenting affidavits, and power of attorney provide a means to secure the authority to make medical decisions for a child without court involvement. With the presumption of capacity, a power of attorney document or supported decision-making (SDM) document can provide disabled adults individualized assistance for making their own medical decisions as an alternative to guardianship. By understanding these complexities, the practitioner can better navigate caregiver challenges and maintain integrity and accountability in patient care.