Ethical challenges in the care of patients with serious illness.

The approach to management of patients with advanced disease and serious illness has been strongly influenced by advances in science and technology, the increasing role of ethics in clinical practice, and the recognition of new rights and social changes. At the present time, decision making is modulated by ethical and legal considerations. One of the challenges of clinical practice is to maintain the delicate balance between the technical aspects and the humanistic aspects of care. For the resolution of this challenge, this article proposes an ethical and legal framework that considers the goals of care and respects the basic values of autonomy, beneficence, and justice. Ethical and legal principles complement sound medical practice but should never replace it. At all times, clarification of the medical situation, good communication, and information about state of the art treatment proposals are essential. In the context of advanced illness, the most prominent issues relate to decision making, justice, and research.