How should you approach end-of-life decisions within CDM?

• A. Clarify goals of care, discuss prognosis and options, respect patient autonomy, and document agreed-upon plans.
• B. Decide on a course without patient input.
• C. Avoid discussing prognosis to prevent distress.
• D. Change goals of care without documenting the plan.

Answer: (A)

End-of-life decisions in clinical decision making rely on patient-centered dialogue that starts with clarifying what matters most to the patient and then aligning available options with those priorities. Begin by exploring goals of care—whether the aim is prolonging life, prioritizing function and independence, or emphasizing comfort—and then discuss prognosis and the full range of options, including what each choice entails, its benefits and burdens, and likely trajectories. Respecting patient autonomy means honoring their values and preferences, even when they differ from what clinicians would choose, and ensuring that the agreed plan is clearly documented in the medical record so all team members understand the current goals, including resuscitation status and any advance directives. This approach supports consistent care across settings and time and helps manage changing conditions. Unilateral decisions without patient input undermine autonomy, discussing prognosis should be honest and compassionate to enable informed decisions, and changing goals of care without proper documentation risks miscommunication and unsafe care.