When discussing end-of-life wishes with a resident, which approach is appropriate?

• A. Only after the resident has lost decision-making capacity.
• B. Whenever the resident asks for details about their care.
• C. During routine care, regardless of privacy.
• D. Respecting the resident’s preferences, involving the appropriate surrogate, and discussing goals of care when appropriate.

Answer: (D)

Discussing end-of-life wishes is about honoring the resident’s autonomy and planning ahead through goals of care and any designated surrogates. The best approach is to respect the resident’s preferences, involve the appropriate surrogate, and have discussions about goals of care when it’s appropriate. This keeps care aligned with the resident’s values and ensures there is a trusted decision-maker if they later cannot speak for themselves. It’s important to have these conversations in private, in a timely and ongoing way, rather than waiting until capacity is lost or waiting for the resident to request details.