The medical providers and the patient/family group both contribute and respond to information from each other. This is not a single event, but a process designed to reach decisions consistent both with the prognosis of the disease and with the values and goals of the patient. The first step of assigning a health care proxy differs from later steps in that it should be routine for all patients receiving medical care, regardless of disease prognosis, and it can be facilitated without specific patient information or medical training. Examples of subsequent decisions are shown without implication of a particular sequence because patients often elect to pursue one life-prolonging therapy while rejecting another. Shared decisions should also encompass interventions for noncardiac indications, such as screening colonoscopy, for which the risk/benefit ratio may be influenced by cardiac risk or by limited life expectancy. The last decisions often create the surroundings that the patient would choose for the end of life. AAA = abdominal aortic aneurysm; DNI = do not intubate; DNR = do not resuscitate; HF = heart failure; ICD = International Classification of Diseases; PSA = prostate-specific antigen.