The unconscious man in his 90s was brought to an emergency room where Dr. Douglas White was a critical care physician. The staff couldn’t find any relatives to make medical decisions on his behalf.

“He had outlived all his family,” recalled Dr. White, who now directs an ethics program at the University of Pittsburgh Medical Center. “We were unable to locate any friends. We even sent the police to knock on his neighbors’ doors.”

Nobody could find an advance directive, either. In the end, the hospital’s ethics committee had to help guide the medical team to decisions about continuing life support.