Case example

Mr. Charles Bauer is a 75-year-old man with several illnesses, including chronic obstructive pulmonary disease (COPD) and congestive heart failure. He lives at home with his wife; they have been married for forty-seven years and have two adult children. He suddenly collapses late one evening, and Mrs. Bauer immediately calls for assistance. The emergency medical services team arrives very promptly, determines that Mr. Bauer is not breathing, begins cardiopulmonary resuscitation, and transports him to the ED of the nearby hospital. In the ED, physicians insert an endotracheal tube to provide artificial ventilation, and Mr. Bauer is admitted to the hospital's MICU.

One week later, Mr. Bauer is still a patient in the MICU; he has not regained consciousness, and he remains dependent on a mechanical ventilator to support his breathing. A neurologist has examined Mr. Bauer; she reports that he has suffered anoxic brain damage and may not regain consciousness. He has also acquired pneumonia and is receiving antibiotics. In view of his multiple and severe medical problems, Dr. Kane, Mr. Bauer's attending physician in the MICU, estimates that his chances of leaving the hospital alive are no better than 20 percent.

Dr. Kane explains the situation to Mr. Bauer's wife and his adult son and daughter, and he asks them what kind of treatment they believe Mr. Bauer would want. In response, Mrs. Bauer expresses her fervent hope for her husband's recovery and insists that Dr. Kane and his colleagues do whatever they can to keep her husband alive.

Mr. Bauer's son, however, disagrees with his mother. He says that his father recently confided to him that he would not want to be kept alive “on machines,” and he gives Dr. Kane a copy of a living will, signed by Mr. Bauer, that states a desire not to receive life-prolonging treatments if he is in a “hopeless condition.” Mrs. Bauer acknowledges that Mr. Bauer prepared this living will many years previously, but she adds that she doesn't believe that he meant it to apply to the current situation. When asked, Mr. Bauer's daughter says that she is not sure what kind of treatment her father would want. How should Dr. Kane proceed?