ABSTRACT
End-of-life decision making has become increasingly important as more people are aging, and they are living longer. In addition, end-of-life care is shifting from survival at all costs to a focus on functional outcome and quality of life. Most end-of-life discussions center around the patient with either chronic illness or cancer. Respect for autonomy, a fundamental tenet of medical ethics, forms the ethical basis for many of the issues that arise at end of life, such as the patient's decision to forego further therapy, or for a patient or their surrogate to withdraw a life-sustaining treatment. Race, religiosity, functional ability, and availability of family support all affect the intensity of treatment at the end of life. Surrogate decision makers are often unprepared to use substituted judgement. They must make decisions based on what the patient would want, or when unclear, decide what is in the patient's best interests.
