Barriers to effective prognosis conversations include knowledge deficits, misconceptions, cultural differences, and lack of motivation. These can be addressed head-on by good communication interventions.

The weight of mentors’ burnout born by students is depicted in this image of arms entangling anguished faces.

A patient’s refusal of tracheostomy during an anticipated difficult intubation prompts critical questions about how to best express respect for a pediatric patient’s autonomy and whether and when deviation from standard of care is clinically and ethically appropriate.

As billable procedures, advance care planning (ACP) conversations need measurable outcomes and training support. Integrating ACP into standard practice is key to ensuring clinicians deliver care that matters to patients.

The AMA Code of Medical Ethics offers guidance on advance care planning, including advance directives, do-not-resuscitate orders, and symptom management.

A hand signing a do-not-resuscitate order is depicted in the foreground of this image of an elder patient surrounded by closed doors and caving walls.

Consideration of what constitutes sufficient information about how donation protocols can interfere with a patient’s dying process is a key feature of consent processes.

Awareness of transference reactions, practicing active listening and reflection, pausing, and articulating one’s understanding of another’s emotional motivations can help cultivate deeper patient-clinician relationships at the end of life.

Countering overmedicalization of death requires acknowledging that dying patients are living patients. It also requires persistent focus on health and wholeness, especially at the end of life, and a solid interdisciplinary approach to supporting dying patients.

End-of-life conversations can be delayed by some physicians’ emotional investment in their patients, as in this case of patient with new onset refractory status epilepticus.