The Only Way Home is With a Hole in the Neck: A Palliative Tracheostomy at the End of Life

IntroductionIn patients with tumor-related airway obstructions, there are unique challenges for the medical team to deliver quality palliative care and meet end-of-life goals.Case DescriptionAn elderly woman with oropharyngeal cancer was hoping to qualify for a clinical trial. However, after multiple admissions for airway obstruction, she elected to pursue a palliative tracheostomy so that she may die comfortably at home, in a state several hours away.DiscussionPatients with unique complications at the end-of-life benefit from interventions that seem "unnecessarily invasive" that allow them to achieve their goals at the end of life. Potential perceived barriers to patients receiving these interventions include code status, lack of adequate support at home, and a misunderstanding of the true nature of palliative care. It is the ethical duty of the interdisciplinary medical team to honor the patient's autonomy while balancing beneficence and nonmaleficence.