One of the most pervasive and compelling issues in bioethics has to do with the host of prickly questions that arise when treatment decisions are made, not by individuals themselves, but by others on their behalf. These dilemmas come to the fore when, for example, patients have lost or are judged to suffer from diminished decisionmaking capacity, are unable to make treatment decisions themselves because they lack the necessary development to do so, or because they choose to give others the task of deciding for them.