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A severely depressed man, weakened by cardiac disorder, refuses lifesaving treatment for his eminently treatable and potentially reversible cardiac condition. Unlike some depressed patients, he manifests no cognitive delusions or distortions: he understands the relevant information about the likely sequelae of treatment versus non treatment and appreciates that they apply to him. He refuses all treatments and also nutrition and hydration because he wants to die. He gives, and apparently has, no reason to refuse other than his wish to die, and there is no reason to think his life would not be satisfactory and enjoyable to him if he were to recover from his current condition. The only explanation for his refusal is that he is severely depressed.
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