it would depend on the patient. if they had a history of multiple significant manic or depressive episodes i would counsel them that their decision was very risky and probably ill-advised and warn them of the likelihood of relapse and clarify what their wishes would be should they relapse. in my experience in people with bipolar i disorder an eventual relapse off medicines is almost always inevitable and i don't know that there is any "natural" way to avoid that. i would encourage regular ongoing monitoring/visits and enlist their family as look-outs on the team. if they had a history of suicide attempts or hospitalization or psychosis in the last few years i would probably urge them against a very dangerous idea and personally not feel comfortable being cast as simply an onlooker to looming disaster. in someone who had a history of episodes long ago who's been stable for at least several years no suicide attempts functioning well they're responsible family is supportive no drugs or alcohol relationships and work are stable/steady and they know what to watch for and could catch a looming relapse quickly so we could nip it in the bud and were agreeable to resuming medicines at the first signs of relapse i would probably be much more encouraging.
if your patient wanted to go off meds and had no major episodes of manic depression for a while what would you advise?