lives, the quality of their lives needs to be understood from the patient's subjective perspective in the context of the broader elements of their physical, functional, emotional, and social situations ( Cella, 1994 ). Dying patients are generally weak and dependent on the care from others, often finding their ability to perform everyday functions impaired. Patients can often feel split between who they are and their illness. When possible, promoting self-care rather than having others perform all dressing changes or having others perform all essential activities of daily living can improve a patient's sense of dignity and wholeness ( Dirkson, 1995 ; Grey, 1994 ) and quality of life while dying. Ethical Obligations and Patients' Rights According to the principles of autonomy (or self-determination), providers and patients have an interdependent, shared decisionmaking relationship that is conducive to enabling patients' self-determination. Providers share their clinical knowledge and expertise, treatment recommendations, and values, and patients use their experience, perceptions, and values. Legally, patients are considered competent to make decisions when they are informed and able to understand the facts, are able to make rational treatment decisions and understand their implications, and can communicate their choices. Clinicians must respect and not unduly pressure patients when they request withholding or withdrawal of treatment, even refusing some or all treatments. Yet when the patient is not competent, the best interest of the patient must then be considered by clinicians and the patient's loved ones; they are challenged to balance potential benefits with previously expressed wishes,