This article examines the legal doctrine and ethical norm of informed consent and its deficiencies, particularly its concentration on physician disclosure of information rather than on patient understanding, which led to the development of shared decision making as a way to enhance informed consent. As a vague and imprecise rubric, shared decision making encompasses several different approaches. Narrower approaches presuppose an individualistic account of autonomy, while broader approaches view autonomy as relational and hold that clinicianpatient relationships grounded in good communication can assist decision making and foster autonomous choices. Shared decision making faces conceptual, normative, and practical challenges, but, with its goal of respecting, protecting, and promoting patients' autonomous choices, it represents an important cultural change in medicine.

Irish playwright Samuel Beckett's spare, compact, and provocative play Rockaby (1981) is a study in old age, isolation, and disengagement from life. In it, an elderly woman rocks in a chair while the audience hears a distant voice remembering her lifelong search for human contact or communion. The play dramatizes the woman's intense physical and psychological isolation and the last sputterings of her impulse to narrate. Such radical isolation may be a necessary precondition for a person relinquishing the narrating that Beckett equates with being, and surrendering unto death. Despite its apparent simplicity, the play powerfully explores the nature of aging in contemporary society, quality-of-life issues for the frail, solitary elderly in our communities and health-care institutions, and how the elderly prepare for life's end in a death-denying culture. Rockaby is thus a text that can help clinicians and other caregivers appreciate the predicament of solitary elderly persons nearing life's end and better understand how we all must manage one day the lonely, self-abnegating yet also paradoxically self-assertive act of dying.

At a time when patient-centered care is a goal and patient safety is a paramount concern across the spectrum of health care, renewed and rigorous attention to interpersonal communication skills makes good sense. In this interdisciplinary article, we share lessons from communication science that can help clinicians communicate more appropriately and effectively with each other and with their patients in healthcare encounters.

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