Direct-to-consumer genetic testing requires that physicians share decision making with patients, not order unnecessary tests or interventions, and refer to genetic specialists when necessary.

This image depicts a dying elder undergoing cardiopulmonary resuscitation, suggesting consideration of the ethical weight of the invasiveness and force of chest compressions.

Physicians new to a case might object to an established care plan. Practice variation, clinical momentum, and how value is assigned by different parties to acute care and comfort measures can each contribute to conflict in these cases.

Clinical momentum—increasingly aggressive treatment in intensive care settings that can violate a patient’s wishes—is charged by ritually intensifying efforts to “save” a patient, reimbursement patterns that privilege acute interventions, and technology-driven health care.

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.

Eliciting the patient’s motives and goals and helping the patient and her loved ones explore alternatives are essential to maintaining trusting relationships and open communication.

Veterans at the end of life have special needs due to posttraumatic stress disorder, environmental exposures, and the influence of military culture on their values. Those who die outside the Veterans Affairs health care system, however, can be at increased risk for receiving outpatient palliative care that is not sensitive to these factors.

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.

Undocumented patients in the United States with end-stage renal disease receive “compassionate” dialysis. Such patients oscillate between being marginally well and “ill enough” to receive dialysis while clinicians wrestle with complicity in a system that both offers and withholds life-saving therapy.

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.