The authors consider the ethical issues involved in a case in which an
elderly man suffering from recurrent, treatment-resistant depression
expressed a wish to forgo life-sustaining treatment should it become
necessary. The patient had no immediate life-threatening medical conditions
but was in danger of becoming malnourished and dehydrated. The authors
conclude that unrelieved suffering resulting from depression, when combined
with repeated treatment failures, may justify refusal of life-sustaining
treatment in very rare cases.