Personal choices--communication among physicians and patients when confronting critical illness

Communication among physicians and patients when confronting life-threatening or terminal illness is often flawed. Medical ethics authorities have suggested the physician or the hospital is responsible to determine a patient's wishes for ongoing therapy; yet, few pragmatic suggestions have been made as to how to fulfill this responsibility. Although advance directives are generally available, they are often misunderstood and rarely used. An educational brochure has been designed to facilitate communication by exposing patients and others to some of the technical and ethical issues that come into focus in the setting of critical illness. The brochure includes a living will. Early experience with this device has been favorable. The hospital ethics committee that developed this brochure believes it can be adapted to other institutions and urges its widespread use.