Mr. Winn

Mr. Winn is a 50-year-old construction worker, who has been separated from his wife (though still legally married) and with a teenage child. He had a history of laryngeal carcinoma diagnosed one year before. He had a total laryngectomy and received radiation therapy, but the disease recurred. His admission was initially prompted by increased shortness of breath and facial swelling following chemotherapy. He spent 2 weeks in the medical intensive care unit (MICU) for stabilization and treatment of pneumonia. Mr. Winn’s primary care physician has encouraged him to consider a "Do-Not-Resuscitate" order, but Mr. Winn’s oncologist feels it is too soon to issue such an order.

Mr. Winn is in increased pain and he has facial swelling, periodic seizures, and has developed a second pneumonia and progressive weakness. At all times, he is bed bound and artificially fed. His pain was relatively well controlled but the facial swelling was uncontrollable. Initially, communication was possible to some extent through hand signals, but Mr. Winn has subsequently lost his ability to communicate. Mr. Winn seems to be deteriorating and his wife and primary care physician want to be put him into palliative sedation and have his feeding tube withdrawn. Mr. Winn’s oncologist, however, stridently objects citing a 5% chance Mr. Winn could still recover.  The oncologist cites the fact that Mr. Winn had not chosen a DNR when the primary care physician offered it, as evidence he wanted to continue aggressive care, but Mr. Winn’s wife is not sure this is what he would have wanted. When pressed, she admits they never discussed such issues and is not really sure what he would want.