A C3 quadriplegic was admitted to our unit, and the whole team went into action to set up a full program of rehabilitation. But the patient decided that he preferred to die. This case raised important ethical questions about patient autonomy and the right to refuse treatment versus medical paternalism, by which the healthcare provider makes decisions on the patient's behalf. This article discusses the ethical principles involved and draws comparisons with other cases cited in the literature. “Tom” is a pseudonym, used to protect the patient's identity. Two Ethical Perspectives follow the article.