critical illness, demoralization, hospice, mechanical ventilation, palliative care, respiratory failure



  1. Delisle, Susan DNP, ANP-BC, PMHNP-BC, ACHPN
  2. Heller, Frances Eichholz LMSW, ACHP-SW
  3. Blinderman, Craig D. MD, MA, FAAHPM


In this case report, an elderly patient with COVID-19 pneumonia and a protracted intensive care course, who was unable to wean from mechanical ventilation, was transferred to the hospice unit for ventilator withdrawal and end of life care. Although symptom management was anticipated to focus on treating acute dyspnea, conditions mandated a shift to addressing the psychological challenges associated with prolonged critical illness. The interventions typical to hospice care-patient centered, family focused, and culturally sensitive-served to alleviate psychological symptoms of demoralization and despair, contributing to an outcome that pointed beyond pulmonary pathophysiology. Thought to be facing imminent death once the ventilator was removed, this patient defied the science behind weaning protocols, which can only be explained by a "will to live," through loving engagement with his family, his favorite music, and a dedicated multidisciplinary hospice team.