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and this again is because you cannot forecast how you will think and weigh risk and benefit in the future under circumstances that you have not yet experienced. Furthermore, advanced directives, including whats now called POLST which is put in many of the charts on admission, cannot encompass every possible scenario. For example, a person says, I do not want to be intubated. I dont want to be on a ventilator. Okay. Lets say that individual develops pneumonia and might need to be on a ventilator for a few days or a week as the antibiotics take effect and then could possibly live well for a year or two. Should he not go on the ventilator? Now, also very much in the public mind is the idea of futility. When is it futile to treat someone? This is really difficult. There have been three major studies in the United States and in Britain in intensive care units and in France in the context of bone marrow transplant, and formulas have been derived, algorithms, to predict futility. And