This ethnographic, ethnomethodological study prospectively examined eight life-prolonging treatment decisions in two long-term care centers in Quebec. This study distinguishes itself from prior empirical studies in this domain by the qualitative methods and the systemic perspective used. The results, contrasting with prior studies, illustrate that the participation of long-term care residents in their life-prolonging treatment decisions is not dependent simply on the communication between the physician and his patient. In fact, the opportunity of long-term care residents to participate in their life-prolonging treatment decisions can be facilitated by effective communication between members of a system of persons found in this setting. These results shift the focus of future inquiry, for both research and clinical practice, from the communication between physician and resident to the patterns of communication between all persons in the clinical setting who know the resident's treatment wishes.