Drs. Curtis and Burt1– and I2 agree substantially. Self-determination is respected when we share information so patients understand and choose what will or will not be done to them. Whether we call this process assent or consent is not important.
Consistent, humble communication throughout hospitalization necessarily complements state-of-the art treatment. Physicians are ethically obliged to describe the risks, benefits, and alternatives of a proposed trial of therapy. During early discussions, doctors should explain that death may prevail despite treatment, and ascertain whether likely paradigms of “success” are acceptable to the patient. Patients begin to prepare intellectually and emotionally for the possibility of failure, and a foundation of trust can be built to best approach end-of-life decision making.