After that meeting, the healthcare team and ethics team backed away from trying to ascertain Ed’s wishes, believing they were harming him more than helping him by revisiting the question. He would not explain why he capitulated in his mother’s presence, nor offer any insight as to why his mother was insisting on keeping him alive. He continued to express his wish to die comfortably to his nurses when his mother was not there. The team continued to palliate his symptoms as much as they could, given that his goals of care remained aggressive. They continued to offer to give him comfort care, and to support him (and his parents) in the face of his mother’s disapproval of that goal. He continued to decline comfort care if his mother was going to be informed and declined the offer to appoint another surrogate. Given the history of conflict and distrust, and the fact that she was still Ed’s chosen surrogate decisionmaker, the staff was not comfortable changing goals of care for Ed without informing his mother. No one brought up the document he had signed. His condition worsened slowly.

Some of his nurses noted that Ed’s mother’s conversation suggested that she believed that Ed had not lived a completely upright life. She seemed to disapprove of his motorcycle riding and hinted that the wreck that caused his injuries may have been intentional. They began to wonder if she believed he was being punished for his “lifestyle choices,” though she would not talk much about her feelings.

Three weeks after the fateful meeting, he took a sharp downward turn and showed signs of imminent death. His physician took Ed’s parents aside and explained that their son was dying, that his heart would probably stop within a few hours, and that it was extremely unlikely that the healthcare team would be able to restart his heart when that happened. He suggested a do not resuscitate order and comfort measures, as had many team members over the course of Ed’s hospitalization. This time his mother acquiesced. Ed’s heart rate declined and then stopped, later that day.

Ed’s parents thanked the nurses for their care of Ed over the course of his months-long stay. His mother added, “I think he is at peace now. I believe he has suffered enough.”