I have not read the article you mentioned but I will look for it.
It is a difficult situation with no easy answer. According to the news reports, the patient had previously discussed some basic advanced directives with family members, indicating among other things that he would not want to live in a wheelchair. We may agree or disagree with this perspective, or may think it is uninformed. But the patient is entitled to his perspective nonetheless. He made it known to his family, and they made the very difficult decision to honor his wishes (likely setting aside their own, aka- substituted judgment) and woke him up to clarify his directives again before proceeding with further heroic measures. We don't have to agree with his decision to honor it.
As for making an informed decision, it sounds like his decision was informed by his pre-morbid values. A life changing event such as this might shake those values, and given the opportunity it is appropriate to clarify his wishes given his new situation. They did this, but he declined further treatment or life support. There are several ethical principles at play, but primary among them (in my opinion) is Autonomy. In this case, his physicians are seeking his informed consent to continue artificial ventilation and proceed with aggressive treatment. Among the alternatives to treatment there is always the option to do nothing, which carries its own potential risks/benefits. Given the opportunity to consent to this treatment, he declined.
If for any reason he was deemed incompetent, based on the ethical principles of beneficence and non-maleficence his physicians may be justified in continuing his treatment in spite of his wishes. If he has a designated healthcare proxy, the physicians would next take direction from that person. If not, it would fall to the the local hierarchy of decision making. Typically it is: spouse, parents, adult children, siblings, other family members, close friends, and then physicians. But each state has its own unique order. I don't know the order in Indiana.
It is natural to want to assist this patient through this difficult transition with an eye towards the future where we envision him appreciating life even within the context of his new limitations. This is what physiatrists do. But force-ventilating a competent but paralyzed patient against his wishes and in spite of his family's attempt to honor his values sounds akin to medicalized torture, is perhaps more horrifying than the alternative, and ultimately seems unethical.
