[When protocols meet reality]

. When protocols meet reality. The JAMA narrative highlights the structural and ethical limits of clinical protocols. While protocols ensure standardization, safety, and accountability, their mechanical application may conflict with patient dignity and vulnerability. In advanced dementia, asking cognitively impossible questions can generate psychological and relational harm, raising concerns about unintended iatrogenic distress. Protocols are designed for typical cases and measurable outcomes, but rarely account for cognitive variability or emotional impact. When system coherence overrides lived experience, care risks losing its human dimension. The key principle emerging from this case is that relationship must precede procedure. Clinicians must be trained not only to apply protocols, but to adapt them responsibly. Without this competence, even evidence-based practice may produce avoidable harm.