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This commentary argues that the problems identified in Kenneth V. Iserson's Essay, "Do you Believe in Magic? Shove, Don't Nudge Advising Patients at the Bedside," are perennial difficulties to which there is no single simple solution. In particular, recent work in psychology offers little help to caregivers, who are in the difficult position of guiding the decisions of their patients while respecting them and ultimately deferring to their wishes. We reflect on Dr. Iserson's article in this journal, in which he suggests that clinicians m