The illusion of patient choice in end-of-life decisions

Over the past two decades a societal consensus has developed around principle that decisions about life-sustaining treatment should be guided patient self-determination. According to the President's Commission, the Center, the American Medical Association, and the US Supreme Court, decisions should be based on the values, goals, and preferences of patient. While theory may emphasize the patient's values, empirical data that other considerations may have a greater impact on decisions about-sustaining treatment. In particular, there is increasing evidence that values may be a more decisive factor than patient values in these.