Caring well for dying patients requires understanding how prognosis, culture, policy, and training shape physicians’ capacities to communicate with and care for dying patients.

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.

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.

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.

Interdisciplinary support, securing reliable information from a patient’s health record, and taking a “who, what, when, where, and how” approach to conversation can improve care planning with dying patients and their loved ones.

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.

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

The World Health Organization and American Academy of Pediatrics recommend disclosing serostatus to sexually active adolescents. What else can be done to improve clinical outcomes and promote public health?

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.

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.

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.

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

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.

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

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.

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.

In end-of-life care, it can be challenging for clinicians to treat patients who might benefit from minimal interventions. They also might struggle to help families make the most of remaining time with loved ones. We speak with Helen Chapple, a professor at Creighton University and expert in end-of-life issues, and Caitlin Doughty, a mortician and author, about what it means for clinicians and health care systems to acknowledge and realize dying in a healthy way.