There are two options.
The patient can undergo the knife sheathed in risks, hold their breath for hours on end as they pray a crucial anatomical element isn’t threatened. It’ll slow the paralysis, help them walk easier—two feet, one in front of the other. Walking may be temporarily easier, but at the end of that trek, by the end of the year, death will have embraced them with open arms.
Or they can leave the hospital. Go home to that fate that not even doctors can change. Death may hover above them as they sleep. Peek over their shoulders as the paralysis creeps in. Graze them lightly as more of their body succumbs to its inevitable fate. But at least they will find comfort—comfort only hospice care can provide.
There are, again, two options.
The patient can undergo the ventilator, they’ll survive if they do. But the patient is adamant; they will never go on the ventilator. It is their choice, after all.
You are the doctor and you have been taught that you work for the patient. That the patient is the master, and yet, you have also been taught never to harm. Is it harm if you’re respecting the patient’s choice, but you know that their choice will lead to a sooner death? Or is it saving a person’s life in allowing them to choose their own fate, albeit quicker?
Medicine isn’t a clear science. It has grooves, crevices, and cracks that are blanketed in dilemmas, humaneness complicating care, and uncertainty. It involves witnessing a patient make a bad decision but allowing them to do so because it is their choice. It involves watching as patients complicate the care they receive by the choices they make. It is not a precise science, by any means.
In the above scenarios, what would you do in the doctor’s shoes? Would you nudge the patient toward one choice because you inherently know what will save their life? Or do you stray away from this, because any input on your part is manipulating the patient’s choice? If they do make the decision that you disagree with, how do you walk the line as a health care provider who exists to ensure that the patient is healthy, and as a person who understands autonomy, and that choices are choices, regardless of if they are bad ones or not.
Atoll Gawande, the author of “Complications,” and a general surgeon, argues for a “personal modus operandi.” Think of this as a scale, where the patient and the doctor must have equal effort into making a decision—the doctor with their medical expertise, and the patient with their autonomy. Neither one triumphs in this scenario, because it is, at its heart, a partnership. 
In the above scenarios, the doctor and the patient would work to make a choice that benefits both parties. In the first scenario, the doctor should lay out all the options the patient has, and discuss with them the choice that is medically most successful but the choice the patient would be comfortable with as well. In the second scenario, the doctor should listen to the patient and compromise, while making a choice that the patient is in favor of.
The personal modus operandi is, of course, not as simplistic as it seems. Medicine is often fraught with the tension of unsolved mysteries and ongoing dilemmas. But if both the patient and the doctor take it upon themselves to discuss and reach a conclusion that they both agree with, perhaps the science of medicine will become less complicated.