In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the author describes an 83-year-old woman with dementia who sustained jaw and other minor fractures post motor vehicle accident. A DNR order was written by the trauma surgeon upon her arrival. Her attending still decided to put her on oxygen (nasal cannula) because she was struggling to breathe and jaw surgery was planned. The patient’s daughter supported comfort care based on substituted judgment, but nurses were skeptical of her motives. A nurse refused a physician’s order to discontinue oxygen and begin comfort care and the author was called again. The author reflects on the responsibility of ethics consultants in patient outcomes, self-doubt, and the case’s unsettling impact on the author.

In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors describe the case of a 55-year-old patient with severe cachexia and malnutrition with a long history of anorexia. Her family helps with ADLs. She was admitted of her own accord for abdominal pain. She declines psychiatric evaluation. She lacked decisional capacity for treatments related to disordered eating like nasogastric feeding. Her husband was always persuaded by his wife at the last minute. The authors are haunted by the question of whether she had an underlying psychiatric issue that was unaddressed, that her husband was not acting in her best interest, and there was insufficient assistance from the psychiatry service.