Deciding in Advance

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Discussions about advance directives should begin before a hospitalization occurs, yet are sometimes initiated at the time of imminent death or during a life-altering medical event. A lack of knowledge in the general public perpetuates this practice because most people do not think about end-of-life choices and do not want to discuss the topic. Yet, family members naturally undertake surrogacy but often find themselves ill equipped to handle the moral and ethical situations that arise. Hence, it is important that health care providers engage patients to consider the completion of health care proxy and living will documents. Provider awareness about general perceptions will facilitate the approaches to initiating conversations about advance directives. This case study highlights the ethical dilemma of an octogenarian whose poor prognosis and lack of an advance directive contributed to an uncertain medical course.

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