Asked if he would call it palliative sedation, Dr. Halbridge said, “This would be called terminal sedation, almost.” He said he hesitated only because the word “terminal” sounded negative and might make the family feel bad, when “it’s really comfort care.” The terms “palliative” and “terminal” were interchangeable, he said.

Speaking with considerable passion, he said he saw himself as the doctor who would not “forsake” patients by telling them he could do nothing for them. If there was no cure, he could at least offer comfort. “We are not gods who can cure everything, and I think at some point in time you have to accept that,” he said, “and to me, it’s the mark of an honest doctor who understands when that time has come.”

The decision to administer terminal sedation was based on a review of the patient’s history that convinced him that Mr. Oltzik was “terminally agitated,” he said. “It means that he is entering the dying process and for whatever reason  whether it’s physical, spiritual  something is interrupting the peaceful passing, and to me, because it’s so uncomfortable for the family and for the patient, that’s the time to medicate the patient and make them comfortable, because no matter what you do, he’s not going to go back to the old Leo that he was.”

He then told a self-deprecating joke about a doctor who gets to the gates of heaven and demands to jump to the head of the line, only to be turned back by St. Peter. But St. Peter opens the gates to someone else carrying a doctor’s bag. “That’s God,” St. Peter explains. “He just thinks he’s a doctor.”

Young residents often challenge him, saying things like, “If I’m 105 years old, I want to be fed, no matter what,” Dr. Halbridge said. His response is, “O.K., but did you ask your patient what he wants?”

Some patients are getting “multimillion-dollar workups” in the intensive care unit, he said, but make their wishes known by pulling out tubes. “I think a light bulb should go off in somebody’s head after the third time he pulls it out. Am I going to change the outcome of this, and if I’m not, why am I doing it?”

At one point, however, Mrs. Oltzik changed her mind.

“She was having second thoughts on that, and then she was saying, ‘I wonder if we should cut back on his medication,’ ” Dr. Halbridge said.