92-year-old woman with dementia was admitted to the geriatric department of a large hospital in Israel for treatment of gangrene in the right leg. The patient’s general physical condition was poor. She was suffering from respiratory failure and had intense leg pain due to gangrene that was only partially relieved by treatment with narcotics. Her conscious state was often hazy. She refused to eat or drink and was receiving supplemental liquid infusions.
Prior to admission, the patient lived with her daughter, who took care of her with extreme devotion. The daughter did not agree to the amputation of her mother’s leg, as she believed her mother would recover, that the gangrene would disappear, and that she would eventually return home. The daughter requested active interventions including mechanical ventilation. When the patient’s condition deteriorated and hypoxemia and hypercapnia set in, she was transferred for further treatment to the internal medicine department as demanded by the daughter. Thus, despite obvious impending death, artificial respiration was applied. The patient died with a tube in her trachea, tied hands, and long-lasting suffering.
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