Management of the Hopelessly Ill Patient: To Stop or Not to Start? Assessment and Decisions in the Perioperative Period

A 75-year-old male was brought from a retirement home to the emergency de­ partment of a county hospital. He had been a heavy smoker ( 45 pack years) but had quit smoking 5 years earlier, after his cigarettes had caused some fire inci­ dents. These episodes, together with decreased concentration and memory and inability to take care of himself had obliged the family (two sons and a daugh­ ter) to admit him to the retirement home. In the past year he had become in­ creasingly demented and required continual supervision. Over the previous six months he also required assistance in performing usual activities such as feed­ ing, washing and changing clothes. He no longer recognized family members and he sat in a chair throughout the day without any communication with those around him.