The closure and the rings: when a physician disregards a patient's wish

SUMMARY. Recent reports document that many physicians do not know their patients' preferences for life-sustaining interventions as part of end-of-life care, or fail to carry out those expressed preferences. This report describes a patient with cystic fibrosis who deteriorated unexpectedly; the physician chose to disregard his patient's preference not to be intubated. As an unintended result, the patient's family was able to achieve closure and find meaning in the apparent final phase of the patient's life. Thus, this report illustrates the delicate balance that must be struck between a physician's respect for a patient's wishes, his assessment of unexpected circumstances which arise as part of clinical care, and his responsibility to acknowledge and allow time for the family to psychosocially and spiritually prepare for a patient's impending death.