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You are the PCP for Rodolfo, a 58-year-old man who suffered a cerebral hemorrhage andhas been in a persistent vegetative state for 18 months.
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You are the PCP for Rodolfo, a 58-year-old man who suffered a cerebral

hemorrhage and  has been in a persistent vegetative state for 18 months. He lives in a nursing home, requires tube feedings and round-the-clock nursing attention, and his care is paid for by Medicaid. He never discussed his health wishes with anyone. Rodolfo's daughter is a nurse in the intensive care unit of your hospital. Rodolfo's wife is deeply religious and has faith that Rodolfo will get better.


Approximately every 6 weeks, Rodolfo develops a urinary tract infection with septicemia and must be admitted to the hospital—often to the ICU—for treatment. Over the course of 2 years, Rodolfo's care has cost $260,000. The hospital ethics committee discussed the case and recommended that tube feedings be withdrawn, or that the next episode of septicemia not be treated, thereby allowing Rodolfo to die. When you discussed the ethics committee recommendations with the family, the daughter agreed but the wife demanded that everything possible be done to continue Rodolfo's life. As Rodolfo's physician, what do you do? Which ethical dilemmas are involved? Autonomy versus beneficence? Autonomy versus nonmaleficence? Autonomy versus distributive justice? Beneficence versus distributive justice? If Rodolfo's care were withdrawn, what would happen to the money saved?

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