Comfort Measures for Severe Diffuse Axonal Injury: A Patient's Last Wish

A physically active 60-year-old male suffered severe diffuse axonal injury due to a motor vehicle accident. His initial Glasgow Coma Scale score was 3. His magnetic resonance imaging (MRI) showed midbrain, corpus callosum, and pontine involvement with intracerebral hemorrhage and bilateral subdural hygromas. He scored 3 on the extended Glasgow Outcome Scale (GOSE) (lower severe disability) and 18 on the disability rating scale. His 14-day mortality risk was estimated to be 83.6% and risk of unfavorable outcome at 6 months 96.0%. Although he did not have a progressive illness or disease, based on the incurability of his condition, his very low level of functioning, and his previously stated wishes not to prolong his life should it be at the point where it now was, a bioethics committee meeting was held. He was then discharged on home hospice and expired peacefully within 24 hours of arriving home.