Anticipatory ethical decision-making. The role of the primary physician.

The complexity of today's medical environment has made decisions regarding life support more difficult. Apparently "simple" personal declarations about life and death often reveal themselves to be inadequate or inappropriate. The tertiary care setting, in which such decisions tend to be made, is the least optimal place to make them. In the ambulatory setting, the trained primary care physician has the opportunity to educate patients and to help prepare them for difficult decisions that can be made in their own best interest before, rather than in the midst of, calamatous events.