Case 1. Euthanasia

1. What is the clinical situation?

This case is based on a widely known right-to-die case in the United States involving a young woman who suffered severe and irreversible brain injury following cardiac arrest. She remained in a persistent vegetative state and was kept alive through artificial nutrition and hydration, with no reasonable expectation of recovery or return to consciousness. The patient could not communicate her wishes, and no formal advance directive existed.

Over time, family members disagreed about whether life-sustaining treatment should be continued. The case entered the legal system and became the subject of national debate, while physicians remained responsible for providing ongoing care within the boundaries of the law.

2. What are the ethical issues?

This case presents a core ethical tension between preserving biological life and respecting patient autonomy and dignity. It raises the question of whether continuing life-sustaining treatment benefits the patient or merely prolongs existence without meaningful awareness. Another central issue is whether withdrawing artificial nutrition and hydration should be considered ethically different from actively causing death. The case also highlights the challenge of making decisions when a patient’s wishes are uncertain and family members disagree.

3. Who is affected?

The patient is most directly affected, as the decision determines whether life-sustaining treatment continues. Family members are deeply impacted, particularly when they hold conflicting beliefs about the patient’s wishes and best interests. Physicians are affected as moral and professional agents responsible for carrying out treatment decisions. Courts, policymakers, and the public are also influenced, as such cases shape legal standards and societal views on end-of-life care.

4. What options exist?

Physicians may continue life-sustaining treatment while legal proceedings unfold. Treatment may be withdrawn if courts determine that doing so aligns with the patient’s previously expressed wishes or best interests. Physicians who believe continued treatment is ethically inappropriate may also seek transfer of care within legal limits. Each option carries ethical, emotional, and legal consequences.

5. What decision is ethically justifiable?

Withdrawing life-sustaining treatment can be ethically justifiable when it reflects respect for patient dignity, acknowledges the limits of medical benefit, and avoids prolonging suffering without purpose. In this context, withdrawal is not an act of abandonment but a recognition that medical responsibility includes knowing when treatment no longer serves the patient’s interests. The physician’s role is to act with honesty, restraint, and respect for human dignity.

Reflection

This case illustrates how ethical medical decisions often occur in situations where clear answers do not exist. Although legal rulings may guide what is permitted, they cannot replace physician judgment. For future physicians, this case demonstrates that ethical responsibility persists even when medicine reaches its limits, and that choosing not to intervene can be as morally significant as choosing to act.