It would be easy to dismiss this as the family’s lack of insight into the patient’s true clinical state, which was admittedly my first thought. But this wasn’t so.

At one point, my patient’s face appeared to contort into a grimace.

“Is she in pain?” I asked.

“It’s hard to tell, but I don’t think so,” one of the sisters responded. “She doesn’t really feel much.” The other sister nodded. Everyone in the room seemed to acknowledge the extent of the damage to her brain.

We talked some more about their family, about her care at the nursing home. The questions I couldn’t muster asking were: Do you think her life has meaning? Do you think you made the right decision, all those years ago?

But by the end of my patient’s stay in the E.R., I think I already knew what their answer would be.

When I was an intern, I recall getting into a lively conversation with a neurosurgeon, a friend who had already finished his training, about the family’s right to choose what they wanted in these situations. I argued that we couldn’t possibly understand or decide for them what was best, when patients are neurologically devastated like this. Who could speak for another’s cultural and religious beliefs, their personal values?

He felt entirely differently, explaining that, as a neurosurgeon, he cared for these patients all the time and that I was too inexperienced in my training to understand. He felt that they are kept on machines for way too long, that their lives amounted to nothing, that if he had it his way it would be our job as physicians to pull the plug — to make the decision for them, regardless of what the family wanted. A heated argument ensued, ending somewhere between him calling me naïve and me telling him he was insensitive and coldhearted.

Years later, I no longer disagree with him, at least not with the same wholehearted conviction. Whenever patients similar to the one I saw that day come into the hospital, my colleagues and I inevitably shake our heads and say to each other, “Don’t let me end up this way. When the time comes, just let me go.” To us, it’s not a life worth living. Of course, we’re also under pressure to care for our other patients, and feeling the strains that our health care system places on all of us.

I can’t say my interaction with this family has changed my overall position on what I would do in a similar situation. If it were me, making the decision for myself or anyone in my family, I would have withdrawn life support. If my patient’s family had asked me what they should have done back then, I would have told them that they should have let her go.