Potential Burdens of Low-Tech Interventions Near the End of Life

Decisions to forgo medical interventions are typically made by balancing their benefits and burdens. Often omitted from considerations is the environment in which the proposed treatment is to be adminitered. A case is presented of a77-year-old man with end-stage pulmonary fibrosis who developmed dependence on high flow oxygen, a technology unavailable in his community outside the hospital setting. Medical staff struggled with the appropriteness of discontinuing the oxygen because it was not the face mask that the paitent found burdensom, rather the setting in which the treatments was provided. The case is discussed from the perspective of clinical ethics, organizational ethics, and the law. J Pain Symptom Manage 2009;37:429-432. (C) U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.