In certain situations, such as case 2 above, significant emotional and physical discomfort for the patient will result if sedation/analgesia is significantly reduced or discontinued. In most clinical scenarios, however, there likely will be uncertainty regarding the effects of such maneuvers on individual patients. Where there is uncertainty, respect for persons would seem to require that a good faith attempt be made to lighten the sedation, with careful assessment of the patient’s comfort and, eventually, ability to interact with caregivers and family in a meaningful fashion. Physicians and family must be careful not to simply assume that discomfort will be the result of a withdrawal of sedation. In particular, the concern about the emotional distress that the patient will experience due to the discussion of medical condition, prognosis, and options is never, in itself, sufficient to preclude an attempt to wake the patient. If a patient can be maintained with minimal or no sedation and clinical illness does not otherwise impair decision-making capacity, then the patient should be allowed to participate in medical decision making. But if significant discomfort occurs during controlled decreases in sedation, or if significant physical and emotional suffering is certain to follow from such a reduction, then other factors need to be considered prior to deciding to withdraw support without continued attempts to involve the patient directly.