Recently I was speaking to a group of sophisticated New Yorkers about the preparation for death. Someone asked a tentative question about life support, and I quickly realized that for all their erudition, they were largely ignorant about what happens in the hospital as people approach death. As a primary care doctor and clinical ethicist, I am often in the position of helping patients and families navigate these questions in real time, sometime at the darkest time of their lives.

I would like to offer some thoughts that might help the reader prepare for these decisions before death is imminent.