Abstract
This article provides the reader with a historical perspective of advance directives, the role of surrogate decision making, and the difficulties families encounter surrounding end-of-life decisions. Illustrated with a case study, it includes a framework for advanced practice nurses (APNs) and other health care professionals to assist families in reaching decisions. The APN can be instrumental in initiating an ethical discussion about resuscitation decisions and assist in dealing with conflicts. The APN can strive to make Do Not Resuscitate (DNR) discussions a consistent part of the hospital experience. It is hoped that the use of such a framework will improve care at the end of life.