End-of-life ethical issues.

COPD is a progressive disorder characterized by intermittent episodes of acute exacerbations, each of which has the potential for producing respiratory failure and a need for mechanical ventilation. The decision to intubate a patient with severe underlying COPD requires a blending of the physician's estimation of prognosis with the patient's life goals, values, and self-perceived quality of life. Decisions regarding intubation and life support are aided by initiating a patient-caregiver dialogue during periods of good or stable health before a medical crisis occurs. These discussions can inform patients about the likely outcome of life support and promote meaningful and valid advance directives.