Last, we agree that different goals of care often are and should be pursued simultaneously. Early in the course of a disease trajectory it is common to pursue cure, longer life, increased function, and comfort. Even in incurable conditions, it is common (at least for some time) to pursue longer life, increased function, and comfort. However, it is also true that sometimes some goals of care are mutually incompatible and need to be prioritized,3,4 such as when a patient has to choose between comfort (resulting in an earlier death) and cure (resulting in a more burdened life) or between being alert (resulting in the ability to communicate with loved ones) and sedated (resulting in greater comfort and the ability to sleep). Since patients must at times choose between multiple preferred goals, we believe it is sometimes clinically necessary to engage patients in dialogue to learn which goal is most important to them.