Recent data suggests that patients with terminal cancer are more likely to receive end of life care that is consistent with their preferences when they have had the opportunity to discuss their wishes with their care provider. Unfortunately, close to 50 percent of individuals over age 85 have dementia, which usually precludes their understanding many of the issues involved in choosing among treatment alternatives [3]. In addition, many cognitively intact elderly are delirious during an acute illness and are incapable of complex discussions about their care when important decisions must be made. Some have cautioned that excessive deference to patient autonomy has the potential to place unwanted and unreasonable responsibility for technical medical decisions on patients or their surrogate decision makers. Given the array of treatments now available for advanced and chronic illness, it is difficult, and at times nearly impossible, for patients or their surrogates to fully comprehend the burdens and benefits of the available options.
Discuss options near the end of life to guide and facilitate medical decisions so that the treatments that are provided are consistent with the patients’ goals and values.
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