Providing good end-of-life care means following the "four R's" that stand for reaching out to identify a health proxy, recording patient wishes, retrieving end-of-life documents and respecting patient preferences, says Dr. Lachlan Forrow, palliative care programs director at Beth Israel Deaconess Medical Center in Boston. He says his hospital expanded that framework to consider more complex issues, such as who should be named a proxy, types of advance planning documents to use, information that should be immediately available and emergency situations where physicians should have leeway to make decisions.

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