Background, material and methods: In this presentation we discuss end-of-life decisions on the basis of the history of a young patient with motor neuron disease and pneumonia.
Results: The patient wanted treatment for an acute pneumonia. Weaning from the respirator turned out to be difficult and the patient's condition was complicated by pneumothorax. He refused further treatment and managed to disconnect the respirator. He even tried self-extubation, but did not succeed, as his muscle strength was impaired. After two days the pneumothorax had spontaneously resorbed and the patient was awake. He refused further treatment and demanded that all therapy be stopped. A meeting was held of the ad hoc established local clinical ethical committee. The patient was conscious, mentally alert and well informed. The respirator was stopped and the orotracheal tube removed. The physician and nurse stayed bedside, ready to intervene if the patient wanted the ventilator treatment re-established, or to give pharmacological treatment for pain, respiratory distress, or anxiety. The patient was calm for five minutes, after that he started to feel respiratory distress. After a short while consciousness was lost, and he died after 30 minutes.
Interpretation: Ethical challenges are discussed. The story illustrates the importance of good communication between patient and doctor to facilitate the patient's autonomy.