I was working day shift in the cardiac intensive care unit, and one of my patients was receiving mechanical ventilation for decompensated heart failure. By midmorning, when the medical team arrived for bedside rounds, a spontaneous awakening trial was occurring. The patient was responding well: drowsy but cooperative and answering yes-or-no questions appropriately. That morning on rounds, the medical team began to consider the patient’s eligibility for a left ventricular assist device or a heart transplant. One of the team members was assigned to reach out to the family to discuss whether they were interested in pursuing these advanced therapies. The team’s discussion was about to move to another topic when I suggested that we directly involve the patient along with the family in that discussion. I will never forget the puzzled looks that greeted my suggestion. However, as I went on...

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