In the medical field today, whenever a procedure is about to be performed on a patient, informed consent must be given to the doctor by the patient before the procedure takes place. Informed consent is the approval given by the patient to the doctor for treatment. In the case under discussion today, an 80-year-old patient with a history of congestive heart failure is in the doctor's office complaining of chest pain. After the examination, the doctor believes that the best solution would be to undergo surgery in an attempt to save the patient's life. During the examination, however, the patient expresses the desire to simply die. There is no living will or Do Not Resuscitate (DNR) on file. The patient's wife is afraid of surgery, while the daughter is willing to do anything that could save her father's life. The first thing that needs to happen in this situation is determining the patient's competency. Using the Understand and Appreciate method to determine competence, whether the patient understands the situation and all options available to them; but also appreciates the options and understands the side effects of treatment or lack of treatment, the patient is felt to be confident. On the other hand, if the patient's requests fall too far outside the scope of what would be considered normal, this could help determine whether or not to ignore the patient's wishes because he or she is no longer considered competent. It is the belief that “it is ethically justified to overturn the grossly irrational decision of a competent patient.” (Fredrick Adolf Paola, 2010) Starting from the assumption that during the last five years of treatment of patient The reasoning behind the refusal may not make sense to everyone, but as long as the patient is deemed competent, the patient's right to choose their own medical care becomes the number one priority. If, on the other hand, circumstances have deemed the patient incompetent, obtaining consent from the next of kin of the court-appointed surrogate is necessary to ensure that the patient receives the best possible medical care and results in an improvement in the situation. quality of life care for the patient. Works Cited Competence in making medical decisions. (n.d.). Retrieved March 7, 2011, from Stanford. Edu: http://www.stanford.edu/group/psylawseminar/Competency.htmFredrick Adolf Paola, R.W. (2010). Medical and humanistic ethics. Juonesd and Bartlett Publiushers. Lecture notes for HLT-305. (2011, 07 03). State University .