The practice of ethics in critical care units. What can we learn simply by connecting with a dying patient?

Among the responsibilities of physicians caring for critically ill or dying patients is the obligation to raise the issue of end-of-life decision making. This should be done before death becomes imminent and presupposes that patients have the right to exercise autonomy, even when conscious capacity is lost. Advance directives, such as living wills and durable powers of attorney, are often either absent or ignored; patients remain content, however, if decisions are made by loved or trusted persons. Physicians can help patients prepare for death by creating a personal connection with them and by not presupposing that patient autonomy means that patients themselves must make their own end-of-life decisions. Rather, physicians should ask patients to designate who will make such decisions - themselves or another person.