Surgery to quieten the yelling of a demented old man.

Robertson comments on a case presented by Gafner in the same issue of the Journal of Medical Ethics. A proposal to crush a laryngeal nerve to halt the incessant yelling of an elderly demented patient is disapproved by a medical center's surgery department for risk and ethical reasons. Robertson, an anesthesiologist, discusses the pros and cons of surgical intervention, but argues that the real issue is the aim of medical care of the severely demented. He commends the hospice approach to cases such as this, where a high level of general care is maintained while the aggressiveness of care is inversely related to the degree of dementia. Robertson also discusses the withholding of antibiotics (the patient suffered from recurrent pneumonias), and of food and fluids, and the role a living will might have played in deciding the course of treatment.