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The grief and anxiety of complex medical illness, with a high likelihood of death, strains communication between medical staff and patients' families in the intensive care unit (ICU). For decades, the emphasis has been on curative intent and a paternalistic approach to decision making, which has been fostered by physicians, when patients are unable to communicate for themselves. However, the past 15 to 25 years have seen a paradigm shift in both what families expect from physicians and what physicians see as the goal of medical (especially ICU) care with respect to the patient and family wishes. This article will address this topic.