“Unfortunately, I think that [ST’s] prognosis is extremely bleak. She has acquired an intolerable disease burden with generalised myopathy, respiratory failure, renal failure, severe gut dysmobility, deafness and severe swallowing problems. [She] is unable to be weaned from the ventilator because her respiratory muscles are too weak. They will remain weak and unable to support her breathing independently. In my experience of managing patients with mitochondrial disease, and more generally neurological disorders, I think it is evident that [ST] has entered a terminal phase of her illness. It is my opinion that the kindest and most clinically responsible course of action now would be to de-escalate the intensive care and make [ST] comfortable.”