If the patient has remained awake and alert, his living will is irrelevant to medical decision making. The potential risks and benefits of mechanical ventilation need to be presented to the patient. If he refuses this therapy with an understanding of the consequences, his wishes should be honored. If he opts for mechanical ventilation, it should be instituted when it becomes medically necessary. The presence of a living will or other advance directive does not obviate the responsibility to involve a competent patient in medical decision making.
Case 1 Discussion
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