Abstract

Background: Surgeons are trained to intervene, rescue and prolong life. Yet when a patient approaches the end of life, the ethical challenge shifts from how to act to whether further intervention remains beneficial. Recognizing this translation requires clinical judgement and ethical discernment. Case presentation: We present the case of a 56-year-old patient with advanced gastric carcinoma complicated by catastrophic gastrointestinal bleeding. Despite maximal surgical and intensive care support, continued escalation would have constituted therapeutic obstinacy. In consensus with the patient and his family, life-sustaining treatment was limited and continuous palliative sedation was initiated to relieve refractory suffering. Discussion: This case illustrates the ethical importance of therapeutic proportionality in surgical practice. Differentiating appropriate limitation of treatment and palliative sedation from euthanasia is essential to preserve professional integrity, avoid nonbeneficial interventions, and respect patient dignity. Shared decision-making, transparent communication, and adequate documentation serve as ethical safeguards. Conclusion: Surgical excellence includes not only technical mastery but also the moral maturity to recognize when cure is no longer possible. Integrating palliative care and limiting disproportionate treatment do not represent failure, but rather a responsible and compassionate expression of surgical practice at the end of life.

Keywords

end-of life care, therapeutic futility, continuous deep palliative sedation, euthanasia, surgical decision-making, palliative care