Euthanasia in intensive care: A 56-year-old man with a pontine hemorrhage resulting in a locked-in syndrome*

Abstract

To describe a case of deliberate termination of life (euthanasia) in intensive care. Case report and review of the literature. A 56-yr-old man experienced a bilateral hemorrhage in the pontine structures and the medulla oblongata, resulting in a locked-in syndrome. The patient was taught to communicate by eye opening. On day 10 after the hemorrhage, he was informed about his diagnosis and prognosis. He was asked if he wished prolonged care, but this was refused. He was offered withdrawal of fluids and ventilation under sedation or deliberate termination of life (euthanasia). He chose euthanasia. The patient was admitted to the intensive care unit and was mechanically ventilated. The patient was euthanized 33 days after the diagnosis by the injection of 30 mg of midazolam, discontinuation of ventilation, and injection of 1.4 g of thiopentone. The tetraplegic aphonic patient was declared competent. His refusal of prolonged care was taken seriously. The requirements of due care according to the Dutch euthanasia act were met in this case. Euthanasia is an option in terminal illness in the Netherlands, but it is very rarely performed in intensive care. This case demonstrates that euthanasia is possible in a conscious patient who is unable to speak or write and who is mechanically ventilated.