This ethical vignette discusses oral advanced directives. When a patient who is unable to make decisions for him/herself has made verbal advanced directives to a single family member, issues and disputes often arise among other family members about the actions the physician should take. This vignette reviews the limitations and legal aspects surrounding oral advance directives, also reviewing surrogate decision-making and family member conflicts of interest.

ACCREDITATION STATEMENT
The AANEM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

DISCLOSURE INFORMATION
 All  authors and planners of this activity had nothing to disclose.

CREDIT DESIGNATION
The AANEM designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

David A. Simpson, DO, MS