its purpose when the patient is imminently dying. The burden of treatment outweighs potential benefits. If a clinician makes the decision to not treat on the basis of their knowledge and experience and considers the burdens to outweigh the benefits, then they may be justified in not offering the treatment. In most instances, the balance of benefits to burdens is not clear in either direction, meaning that such interventions are considered optional. Part of the challenge in providing care is that predictions of life expectancies of the terminally ill are imprecise ( Rhymes, 1990 ). As a result palliative care for the dying may never be given, and patients may receive care that offers no benefit. Interventions such as antibiotics and wound irrigation would then be considered optional. Making the decision for or against optional interventions according to the merits of a particular intervention need to be made jointly by health care providers and their patients (and their families). Although clinicians may feel obligated to continue life-sustaining treatments or reluctant to withdraw these interventions, nurses are obligated to represent and advocate for the best interests of the patient. Nurses need to be effective advocates for dying patients to achieve what the Institute of Medicine ( IOM, 1997 ) defines as a "decent and good death -- one that is free from avoidable distress and suffering for patients, families, and caregivers; in general accord with patients' and families' wishes; and reasonably consistent with clinical, cultural, and ethical standards" (p. 4). As