This article was first published in the February 2019 issue of Critical Connections. The Exploring Ethics column features a case study and analysis meant to help readers gain a better appreciation of ethical issues facing critical care practitioners. 

CASE STUDY  
A 79-year-old woman with a past medical history of hypertension, hyperlipidemia, and prior stroke presented to her pulmonologist with a progressive worsening dysp-nea on exertion. She had a positive cardiac stress test and underwent cardiac catheterization, which demonstrated triple vessel disease. She was referred to a cardiovascular surgeon for myocardial revascularization. Her preopera-tive carotid ultrasound demonstrated a critical left carotid stenosis. She agreed to a dual procedure—triple coronary artery bypass graft and left carotid endarterectomy. An advance directive was in place granting her daughter durable power of attorney. The patient stipulated in her instructions that “I object to all life-sustaining treatments in all circumstances even if my doctors think they might help me.”

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