Tough calls: making ethical decisions in the care of older patients.

Medicine is a moral endeavor concerned with the good of treating those who are ill. An ethical decision is the justifiable response to a "should" question, with consequences of good or harm. Three conditions are necessary for a patient to share in making an ethical decision: competence, voluntariness, and knowledge related to the condition of illness. In cases of incapacity, either the standard of substitute judgment or of best interest may be applied. Ideally, an ethical decision is a shared decision between providers and patients. In cases of conflict, continuing communication and dialogue are morally superior to the use of power.