A competent patient has the right to refuse treatment necessary to sustain life. However, for many end-of-life decisions, we lack direct access to the wishes of a competent patient. Some treatment decisions near the end of life involve patients with severely diminished mental capacity (for example, Alzheimer's patients), some involve patients who are unable to communicate (for example, some stroke victims), and some involve patients who are simply unable or unwilling to participate in decisionmaking due to the nature or severity of their illness.
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