Potential burdens of low-tech interventions near the end of life

Decisions to forgo medical interventions are typically made by balancing their benefits and burdens. Often omitted from consideration is the environment in which the proposed treatment is to be administered. A case is presented of a 77-year-old man with end-stage pulmonary fibrosis who developed dependence on high flow oxygen, a technology unavailable in his community outside the hospital setting. Medical staff struggled with the appropriateness of discontinuing the oxygen because it was not the face mask that the patient found burdensome, rather the setting in which the treatment was provided. The case is discussed from the perspective of clinical ethics, organizational ethics, and the law.