I have an elderly patient at the end of her life. Her medical condition is deteriorating slowly but surely, and she doesn't know what she wants to do, or if she does know, she's not great at telling me.
Of all the things that could possibly end her, the malady is dysphagia. She can't swallow. The answer is to put in a PEG tube and start enteral feedings. The alternative is hospice. Either choice in her situation is reasonable. She could go either way, and no one could fault her for it. But she doesn't know, and asks me what she should do.
I wish I could tell her what to do. I wish there was a right answer. I know what I would do in her situation. I'll be damned if someone's sticking a feeding tube in me. Fuck anyone who tries to prolong my solitary existence. I was ready to exit this world at the age of 17, so the thought of shooting for 100 is nauseating to me. But she's not me and I'm not her, and I can't tell her what the 'right' decision is.
Sometimes, medical paternalism is nice. Sometimes, I really want to tell this wonderful person that I know what to do, and that I know the right answer. But I'm not God. I can only guess.