title: Issues surrounding end-of-life decision-making.
abstract: End-of-life decision-making is a complex process that can be extremely challenging. We describe a 42-year-old woman in an irreversible coma without an advance directive. The case serves to illustrate the complications that can occur in end-of-life decision-making and challenges in resolving difficult futility disputes. We review the role of advance directives in planning end-of-life care, the responsibility and historical performance of patient surrogates, the genesis of futility disputes, and approaches to resolving disputes.
authors.affiliation: Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Vickram
authors.initials: V
authors.lastname: Tejwani
authors.forename: Yifan
authors.initials: Y
authors.lastname: Wu
authors.forename: Sabrina
authors.initials: S
authors.lastname: Serrano
authors.forename: Luis
authors.initials: L
authors.lastname: Segura
authors.forename: Michael
authors.initials: M
authors.lastname: Bannon
authors.forename: Qi
authors.initials: Q
authors.lastname: Qian
keywords: advance directive; conflict resolution; end-of-life care; futility dispute; surrogate