Case Studies: Who Speaks for the Patient with the Locked-In Syndrome?

A case is presented involving a nursing home patient who suffered a stroke that left him unable to speak or move, and thus unable to communicate his wishes except through eye movement. Steffen ponders several questions related to whether this patient should be given life-prolonging treatment, including whether he is competent to give or withhold consent, how a guardian could justify a third-party consent or refusal, and whether the attending physician could write a "do not resuscitate" order without the approval of the patient's guardian. He concludes intuitively that life-sustaining therapy should not be given in view of the patient's quality of life and the burden of his illness. Franklin disagrees, contending that it is unfair to withhold life-sustaining therapy because a patient cannot communicate and that there is an increasing number of cases on record of patients with locked-in syndrome who have recovered or have learned to communicate through Morse code or computers. (KIE abstract)