"As a professional who has seen this desperation many times, it is my responsibility to keep my patient anchored in reality, as disappointing as it is. By this time I would assume both patient and family were on board with this reality and how my obligations may have to shift from the temptation to fool ourselves to one dedicated to the final dignity of life well-lived."

Sometimes in medicine you just run out of answers, choices, ideas, or hope. Everything has limits, from how low a hemoglobin can get and still oxygenate tissues to end-stage victory of tumorous tissue over the healthy tissue. This question wants to know how you throw in the towel in a field in which you are expected to never give up or surrender.

"When I first compose a protocol specifically designed for my patient, I review it thoroughly with him or her, from its hopeful beginning to the many possible ends--good and bad. By the time we get to a time of surrender, I would review it again as we did in the beginning so the timeline, in arrears, could demonstrate everything's been done that could be done. I would assure the patient I am available for any 'good' surprises that may happen and for any end-of-life plans he or she wants to implement."