Summary Lack of information about the patient’s medical history and the exact circumstances of the cardiac arrest might result in efforts to resuscitate a patient with a very poor prognosis. This report describes the case of a patient with a T4-adenocarcinoma of the lung, who received basic life support by his next of kin after witnessed hypoxic cardiac arrest. Following the administration of 1 mg of epinephrine and the return of spontaneous circulation, but before endotracheal intubation, the rela­tives - both medical doctors - requested that further life-sustaining treatment be withheld. The attending emergency physician contacted the anaesthesiologist on call at the hospital department responsible for organising the emergency physician system. In accordance with the in-hospital do-not-attempt-resuscitation guideline, the anaesthesio­logist recommended that written confirmation of the diagnosis and evidence of a presumptive living will be obtained. Both a medical report and a power of attorney including an advance directive confirming the patient’s wish not to receive critical care treatment were available. Thereupon, mask-bag ventilation was terminated. The patient died shortly thereafter without regaining consciousness and attended by his close relatives. Successful initial cardiac resuscitation in this case subsequently presented the attending emergency physician with an ethical dilemma, which was resolv­ed with the help of the hospital anaesthesiologist, who provided information from the in-hospital do-not-attempt-resuscitation guideline. Out of respect for the patient’s autonomy, life-sustaining therapy was withdrawn and the patient allowed to pass away in his home environment.