Your cancer patient has as favorable diagnosis, but asks you to sign an advanced care directive that disallows aggressive resuscitative measures; how do you counsel her not to give up that easily?

"Patients have certain rights, but deciding on a course that is just based on ignorance is not one of them. I would include her family in my frank discussion about how her case is completely salvageable toward a complete and normal life and make sure I can document their understanding. If she still refuses certain things that are indicated and, frankly, excellent ideas, I would get an informed consent on what is being given up, but still pledge to step in wherever I can if needed or a change in her mind occurs. I would make sure she understood how such a plan may close certain windows of opportunity toward that complete and normal life."

This is a question that wants you to declare, in no uncertain terms, that you know better. And you do. So don't be afraid to say it. 'Above all, do no harm' means that, among the obvious ways you can harm your patient, you also pledge to not allow your patient to harm herself out of ignorance. You have a role as an educator and an obligation to put her on the same page, clinically and ethically. It's all part of care as much as surgery, chemotherapy, and radiation.

"It is my duty to inform my patient that her life is worth aggressive resuscitative measures, especially when they are likely to be successful. Hers is obviously a matter of an incomplete understanding of the prognosis, which is favorable."