Daring to Discontinue Life-Sustaining Treatment

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Editor’s Note:[1]

This column presents a problematic case—one that poses a medical-ethical dilemma for patients, families, and healthcare professionals. As this case is based on a real medical situation, identifying features and facts have been altered in this scenario to preserve anonymity and to conform to professional medical standards. In this case, the family is forced to honor the patient’s request to terminate life-sustaining medical care.

Question: Is it ethically permissible for this young man to stop his ventilator so he will die?

David is a 34-year-old man who has been on a ventilator for 9 years. He was re-admitted to the hospital two weeks ago for treatment of recurrent pneumonia and has improved. He asked yesterday if his ventilator could be stopped.

Nine years ago, he sustained a neck fracture in a diving accident that left him quadriplegic and ventilator dependent. He went to a rehabilitation facility where his family learned to care for his medical needs, and he was discharged home on ventilator care. His pulmonary situation was stable for several years. He was able to be off his ventilator for several hours at a time and go out in his van with friends. However, in the past two years he has had ten hospital admissions for atelectasis[2] or infection. His secretions have increased so that he requires suctioning several times through the night, and he is no longer able to be off the ventilator for even short periods. He has had vigorous treatment with antibiotics, chest physical therapy and repeated bronchoscopies, and it is the consensus of his care team that his pulmonary situation will not improve and will likely steadily deteriorate.

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