Well, it just so happens that she was my last patient before lunch, so I invited her to get dressed and come talk to me in my office.  After about 45 minutes, she had a "To Do List" and we had done some internet research and phone sleuthing to find the information she needed about where her parents were buried, when the seminar on "Music selection for your Memorial" would next be held.  I asked questions and she provided answers. She had her homework, because for some questions, she needed more time to think, for others, we brainstormed how to bring up the topic with her kids and she thought about which of her kids would be most likely to listen to and follow her wishes.

Over the next few months, she completed an advanced directive, talked to her oncologist and a long list of other tasks, including writing letters to her kids and deciding which family treasures were to go where. Never once did I prescribe medication to her.  Never once did I encourage her to continue or to stop her treatment.  I was just the person who listened to what she wanted and helped her communicate her  
wishes to her family.  She came in to the office beaming on her next visit.  She said, that she felt more at peace because she felt less overwhelmed and that she was more in charge.

Sometimes, it just takes someone in a white coat to ask the questions and provide options or resources that they may not have considered.  It also takes someone who's not afraid to talk about death. Often the  
family is so emotionally wrecked that it's an unfair burden for them to be able to talk about their loved one's impending death.  Who else will help a person preserve their dignity when they are coming to the end of their life?