Richard Rudd lay comatose on life support in a British intensive care unit last year after a horrendous motorcycle accident left him seemingly unconscious and a quadriplegic.
The 43-year-old former bus driver and divorced father of two teenage girls had watched a friend deal with paralysis and told his parents he would never want to live that way.
Rudd's parents took him at his word and asked to have their son, who had severe brain injuries, taken off the life support machine.
As doctors began discussions and moved closer to supporting the family's decision, Rudd began to blink his eyes.
Soon, they realized Rudd was in a "locked-in" state, able to think, feel and hear, but unable to speak.
So for the next three weeks, Dr. David Menon, an intensive care specialist at Addenbrooke's Hospital in Cambridge, worked to get Rudd to communicate with his eyes, answering simple questions.
Menon asked Rudd repeatedly if he wanted to live and he blinked that he did -- an agonizing drama that played out in a BBC documentary that aired this week about patients with brain injuries, "Between Life and Death."
"It allowed time for him to declare himself," Menon said. "The family was not certain it was in his best interests, and we weren't certain either. We didn't know what his wishes were."
Rudd hadn't left a living will. But even if he had, doctors and ethicists say people can change their mind.
Life and death decisions are "tempered by our circumstances," according to Menon. "People must have choices."
"If you were 50 years old recovering from spinal injuries and your daughter was pregnant and you were going to be a grandmother, you might want to stay around for to see if the grandchild grows up to go to law school or medical school," he said.
"We know that people who have spinal chord injuries describe life as better than I would describe being on call for a week," said Menon. "Even with some dependence, they describe a good quality of life, not their physical ability, but their social interactions."
Rudd's case is strikingly similar to one in Belgium last year when doctors revealed that Rom Houbens -- thought to have no brain activity since a 1983 car crash -- had actually been paralyzed and was fully conscious, able to hear everything around him but not respond.
It also echoes the story of Terri Schiavo, the Florida woman who was artificially kept alive for 15 years.
Schiavo, who had been diagnosed with a profound brain injury, was at the center of a seven-year legal battle before a judge granted her husband the right to allow her to die in 2005. Her family claimed all along that she was not in a vegetative state.
Locked-in syndrome was first identified in 1966 and occurs when the lower brain and brain stem are damaged, often by a stroke, paralyzing all voluntary muscle movements.
Usually the upper brain, which is responsible for thinking, is left intact. The only means a patient has to interact with others is through vertical gaze and upper eyelid movements, according to Mayo Clinic researchers.
The syndrome has been described as the closest thing to being buried alive and when it is total -- with no eye movement -- it is usually fatal.
In October of last year, Rudd was thrown 20 feet from his motorcycle when he was hit by a car pulling out of a gas station and was immediately paralyzed.