The hour is late and the situation dire. Huddled by the patient's bedside, a nurse and respiratory therapist stand just behind the physician who speaks to the family members. Sometimes the patient is a child—perhaps an infant, just born, with severe congenital anomalies, or maybe a toddler who fell into a pool and nearly drowned. Other times, the patient is far older, and may have had a sudden massive heart attack or may have been living with progressive cancer for months or years. The family members could be young parents or a spouse married half a century. The conversation focuses on the patient's history and diagnosis, the gravity of the predicament, and the possible treatment options, outlining the possible benefits and harms.