Mr. E is a 35-year-old man with advanced AIDS who has recently been diagnosed with AIDS-related dementia. When he still had decision-making capacity he told his partner, but not his close family members, that if he ever “lost his mind” because of his HIV infection, he would want to receive only comfort measures for any new medical problem. During the past two weeks Mr. E's caregivers have noticed that he is having increasing difficulty breathing. In view of his medical history they think he probably has a recurrence of Pneumocystis carinii pneumonia (PCP). Mr. E is brought to the hospital for a chest X-ray to confirm these impressions. This shows probable PCP. The physician knows that Mr. E has had a lot of difficulty with adverse drug reactions in the past and wonders whether or not the patient should be admitted to the hospital for further investigations and treatment.

Mrs. F is an 83-year-old widow with advanced chronic obstructive pulmonary disease (COPD) and osteoporosis. Approximately six months ago Mrs. F was hospitalized for six days because of an acute exacerbation of her COPD. Since discharge, her breathing has not improved to her prehospitalization status. Three months ago, she moved into a nursing home because of her deteriorating health and difficulty in caring for herself. In the nursing home, she has shortness of breath at rest, which is made worse with eating.[…]