Patient B, a 70-year-old female, with a history of dementia, stroke and pneumonia, was admitted to the emergency room of a private hospital in a coma. She had advanced lung cancer and was well-known to the physician, Dr Y, who was called to see her. There was no living will but, in the past, B informed Dr Y during a consultation that should she become so ill that she can no longer decide on appropriate treatment herself, and if there were no reasonable prospects of recovery with aggressive treatment, she be allowed to die peacefully with only fluids and pain medication being administered. 

This had been documented clearly in Dr Y’s clinical records. Dr Y informed the family members of his previous discussions with B. He also informed them that he did not believe that there was a reasonable prospect of meaningful recovery, should he ventilate B and administer aggressive treatment. This opinion was shared by a senior colleague who had also evaluated the patient at his request. All the family members disagreed and requested that “everything possible” be done to save/prolong B’s life. 

Dr Y sought legal advice and was advised that he would be acting within his rights if he were to decide not to commence with aggressive therapy and that this should be carefully documented. However, in view of the high likelihood of a complaint by the family, it would be advisable to obtain a court order to protect Dr Y’s position.