There is an increasing expectation in society that clinicians will engage patients as partners in selecting medically appropriate treatment options rather than simply dictating what treatments patients will and will not receive. To be sure, this is a positive advance that recognizes citizens in multicultural societies have diverse values and will likely have different treatment preferences for a variety of medical decisions. One implication in intensive care units (ICUs) is that patients vary regarding the amount and type of treatment they are willing to accept in the face of advanced critical illness.

This collaborative approach to decision making requires a degree of clarity about which medical options should be described and offered to patients. Unfortunately, the boundaries of acceptable medical practice in patients with advanced critical illness are poorly defined for some circumstances. For example, there is disagreement about whether patients in a persistent vegetative state should be offered intensive...

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