This chapter presents a case study of a 41-year-old female with hepatitis C cirrhosis complicated by hepato-pulmonary syndrome. Adults with appropriate decision-making capacity express their autonomy through the informed consent process. Physicians demonstrate respect for the autonomy of competent patients by accepting their informed decisions, whether or not they consent to medical treatment. Key questions arise in most cases involving Jehovah's Witnesses (JWs) and others who refuse certain types of treatment on religious or other grounds. Due to strongly-held beliefs, most practicing JWs patients refuse transfusion of blood and many blood products. Respect for patient autonomy is the primary ethical principle applied in the United States, while the principle of beneficence is more strongly held in many other countries. Respect for autonomy supports the concept that adult, competent patients have the right to refuse blood transfusions, as well as any other therapy.

This chapter presents a case study on an 86-year-old retired accountant, experiencing worsening symptoms and signs of congestive heart failure. The patient clearly understood and accepted the balance of benefits versus risks, and gave informed consent to the procedure. Offering the operation is respectful of the ethical principle of autonomy. The patient's primary goals were to improve his functionality and reduce his symptoms even with a substantial risk of dying. The chapter discusses questions that need to be addressed when the outcome of the intervention is poor and the possibilities of achieving the patient's stated goals are virtually nil. The focus should be on the overall trend and not the minor ups and downs of vital signs, drug infusion rates, ventilatory settings, etc. It is important to recognize that it will take time, perhaps days, for the family to grasp the lack of improvement or deterioration in the patient's condition.