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t nightfall on December 31st 2005, Dr. Michael Ellis DeBakey was alone in his house when he felt a strong chest pain. A few minutes later the pain was unbearable, spreading to his neck and after to his back. As a surgeon, Dr. DeBakey immediately diagnosed acute aortic dissection and he knew that he would certainly die within a short time. This would be the best way of alleviating the pain he thought. Dr. DeBakey preferred to hide the severity of his situation from his family by staying at home rather than going to hospital. Eventually after three days, he agreed to perform computed tomography. The examinations showed an acute type II aortic dissection, using the classification of Dr. DeBakey himself. To general dismay, the patient demanded to return home, where he remained under the care of physicians and nurses. His situation worsened and, still protesting, he went to the Methodist Hospital in Houston, almost a month after the first symptoms. More examinations demonstrated that the dissection had become more extensive. Now there was fluid in the pericardium sack with signs of tamponade. Despite this, he passionately refused surgical treatment repeating: “I prefer to die”. At the beginning of February, due to worsening of his clinical conditions and loss of lucidity, the medical team decided to operate on him. To them the only contraindication was his age. Then, several problems appeared. The anesthesiologists of the hospital refused to put the patient under anesthesia due to his age and his precarious physical condition. They argued that never such an elderly person had been submitted to such a large surgery. Administrators, lawyers and surgeons discussed the situation and convened the Ethics Commission of the hospital which met late at night. The members of the commission wanted to abide by the laws of the State of Texas, which establish that physicians must always respect the wishes of patients and family. The real question was whether to follow the wishes of the A 97-year-old patient in shock with acute aortic dissection operate or not? Editorial

Paciente com dissecção aguda da aorta em choque, com 97 anos de idade: Operar ou não operar?