ABSTRACT
One of the most difficult ethical struggles in health care occurs around decisions made as a patient nears the boundary between life and death. Whether the patient is at the end stage after years of chronic illness or has a more recent acute illness or injury, making decisions that are respectful of the patient and in the patient’s best interests is far from straightforward. Asking how aggressive the clinical interventions should be shifts the goals of medical care beyond the traditional ones of prevention, improvement of function, and cure to developing new shared goals. What ideally evolves is a holistic concern for the patient’s preferences, for comfort and dignity and relief of symptoms, as well as psychological and spiritual support of the patient and family. The goals should include minimizing the harm of medical intervention and maximizing the quality and nature of the life yet to be lived.
