AMA Journal of Ethics^®

Case

After following the appropriate procedural steps, including consultation with the hospital's ethics committee, the physician's judgment is confirmed: Mrs. Scott is requesting futile care. Dr. Lee recommends that she see a medical oncologist (not a surgeon) for a full assessment and treatment alternatives, and he offers her information about hospice care. Not surprisingly, Mrs. Scott requests a referral to a different surgical oncologist, hoping she will find one who disagrees with Dr. Pandihar's judgment. Dr. Lee provides her with this referral, also.

Several weeks later, Dr. Lee notices that Mrs. Scott has an appointment that afternoon. Dr. Lee doubts she found a surgeon willing to perform the surgery, and he guesses she's back for another referral. He gets Mrs. Scott's chart and heads to exam room 2.

As he enters, he gives his usual greeting, "Hello, Mrs. Scott, and how are you doing today?"

"Not too well."

"The nurse said you didn't explain exactly why you're here today."

"I didn't want to get her involved. You see, Dr. Lee, no one will do the surgery. They all tell me that I only have 6 months to live. I'm sorry I blew up at you and Dr. Parihar, but I..." she trails off.

Dr. Lee speaks comfortingly, "As much as I would have preferred it didn't happen, it's an understandable reaction to such grave news. Did you meet with the medical oncologist, and were you able to get in touch with the hospice care facilities I recommended?"

"I met with the medical oncologist and he confirmed that I have a few months to live. He also gave me some information about some hospice places." She pauses. "Dr. Lee, I want you to give me a prescription for barbiturates. I don't want to spend the last few months of my life in agonizing pain. I watched my father die a painful, slow death, and I don't want any part of that. I want some control over how I die. I know this could put you in a compromising position, so I should also tell you that I've had some pain that regular strength pain killers do not alleviate. Please, Dr. Lee, just give me the prescription."

What should Dr. Lee do? (select an option)

A. Prescribe the barbiturates and inform Mrs. Scott of the proper dosing levels for pain treatment and the amount that would result in an "overdose."

B. Inform Mrs. Scott that he will not prescribe barbiturates for the reasons she has suggested, but that he will prescribe appropriate pain control.

C. Inform Mrs. Scott that she will have to ask another physician for assistance in ending her life and give her contact information for several other physicians.

D. Recommend Mrs. Scott see a counselor, either pastoral or otherwise, or undergo a psychological evaluation.