Box 1.

—Clinical vignettes

Vignette 1

You are in hospital recovering from a sudden stroke. It has left you half paralysed from which you are unlikely to improve. You cannot speak but you can understand. You cannot swallow food safely. There is a high risk that food directly enters your windpipe and makes you choke.

 Your doctor explains that, in order to feed you adequately and safely, he needs to use a feeding tube which passes through your nose into your stomach. This is likely to make you live longer but you need the tube all the time. The other alternative is that you are kept comfortable, but without a feeding tube.

Vignette 2

You are in a nursing home. Over the past few years you have become forgetful and occasionally confused. You have Alzheimer’s dementia. You are able to recognise relatives and nursing home staff. You are in good physical health. You seem happy and contented. However, your memory problems are going to get worse. One day you pass some blood from your bowel.

 You can leave it and not have any tests. Or your doctor can organise for you to have some tests to see where the bleeding is coming from, followed by surgery if a cancer is found.