When you cannot speak for yourself, someone else must.
In emergency departments, operating rooms, and intensive care units, clinicians need an answer fast—often before families have grasped what’s happening. Who decides whether a new medication is started, a breathing tube is placed, or treatment continues?Without a clear answer, the hospital moves ahead by default. Care advances incrementally, decision by decision, across hours and clinical teams. The breathing tube stays in. Sedation deepens. Each step is meant to stabilize, to buy time. Each one makes sense on its own.
By the time families discuss wishes, the question is no longer whether to begin, but whether to stop.
This default path carries real weight: pain, side effects, prolonged suffering, mounting costs, and the risk of treatment that overrides what the patient would have wanted or even violates their deeply held values.
