A competent patient can decide

In the case of the 80-year-old lady with COPD, if clinical examination suggested that the lady was alert and capable of deciding about whether she would consent to use of mechanical ventilation, I would go by her decision, and discuss this with the daughter and son-in-law. However, a less traumatic mode of therapy called “non-invasive ventilation” is now available, which does not entail inserting a tube into the patient’s trachea. Most patients who have received mechanical ventilation are really distressed by the presence of the tracheal tube and the inability to talk, cough or consume food / water while the tube is in place. Some of these are avoided by non-invasive ventilation. However, this can substitute for conventional mechanical ventilation in only a few, very limited conditions. Fortunately, the present case seems to be one such situation.

If on the other hand, the old lady is not in a condition to decide for herself during the present illness, then it would be up to the daughter and son-in-law to decide about whether or not to subject the patient to ventilation. They would have to be told about the nature of the chronic disease, the acute problem, the possible outcomes, and the possible risks and benefits of ventilation (the medical aspects of the problem). They would also have to consider the views that the patient may have expressed earlier about not wanting to go on ventilator (the ethical aspects). Their decision should be respected by the treating doctor. Ventilation could be withheld, if so decided, after properly documenting in the patient’s case records, the circumstances and reasons for withholding potentially life-saving treatment.