This case not only exemplifies a number of the common ethical challenges arising in the ICU, it also illustrates some of the problems inherent in end-of-life decision making. While not frequently encountered in the day-to-day practice of the rheumatologist, we should be familiar with these concepts because they may arise in the setting of rheumatic disease care.
Dr. MacKenzie is associate professor of clinical medicine and public health at Weill Cornell Medical College, Hospital for Special Surgery, New York.
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