In the end-of-life state, individuals may become incompetent and be unable to make decisions on their healthcare because of an impairment of consciousness, impairment of intelligence or other factors. Ethical difficulties arise here. Who should be enabled to make decisions in such a case? How can we make decisions for others? Several factors must be considered, such as precedent values, current benefits and burdens, the wishes of the family, the judgement of healthcare providers, and other parties. The consideration of these factors leads us to explore surrogate decision-making that would maintain the patient’s dignity and best interest.