Forgoing treatment in an adult with no apparent treatment preferences: a case report

This article reports in detail an ethics case consultation involving a decision to forgo life-sustaining treatment for a middle-aged man following a "massive" cerebral bleed resulting in profound brain damage, but not unconsciousness. An unusual feature of this case is that, despite normal intelligence, caring family relationships and a history of life-threatening cardiac disease, vigorous and sustained inquiry could not elicit any indications of this patient's values, perceptions or preferences regarding end of life care. Other than a deliberately autobiographical methodological prologue and a few brief comments at the end, the case is presented straightforwardly and without intercurrent analysis.