Making difficult choices at the end of life: a personal challenge for all participants

With the modern ability to sustain life well beyond its natural limits questions about restricting treatment, identifying patient preferences, and the expectation that psychological as well as physical needs be addressed are part of the challenge. Physician beliefs and values should be considered when treatment goals are discussed with patients nearing the end of life. This allows the physician to balance them with those of the patient and to place them in the context of professional obligations even when beliefs conflict. Sharing beliefs with patients may strengthen the relationships and minimize conflict, but this should be done cautiously and in context of the patients' needs and the clinical circumstances. Care should therefore be taken to respect the moral sensitivities of all participants when difficult choices are to be made at the end of life.