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Table of Contents
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
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17. Euthanasia
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Cure sometimes, treat often, and comfort always.
~ Hippocrates
Mercy's Dilemma
The Ethical Dilemma of Euthanasia in End-of-Life Care
Dr. Jane Sanders, a renowned oncologist at St. Mary’s Hospital, was known for her compassionate care and dedication to her patients. She had been treating Mr. John Parker, a 65-year-old man with stage 4 lung cancer, for several months. Despite her best efforts, Mr. Parker’s condition continued to deteriorate, and he was in constant pain and suffering.
One day, Dr. Sanders was surprised when Mr. Parker requested a private meeting with her. During their meeting, Mr. Parker told her that he had heard about a controversial procedure called euthanasia, where a physician administers a lethal agent to relieve a patient’s suffering. He asked Dr. Sanders if she would be willing to perform the procedure on him. Dr. Sanders was taken aback and immediately explained to Mr. Parker that euthanasia was illegal and considered unethical in the medical profession.
Over the next few days, Dr. Sanders noticed that Mr. Parker became increasingly agitated and depressed. He was not responding well to pain medication, and his condition seemed to be worsening. Dr. Sanders consulted with a palliative care team and a mental health professional, but Mr. Parker’s condition continued to deteriorate.
One morning, Dr. Sanders arrived at the hospital to find that Mr. Parker had passed away overnight. She was surprised to learn that the cause of death was a lethal dose of medication that was not prescribed by her or any other physician on Mr. Parker’s care team.
A full investigation was launched by the hospital administration, and it was discovered that a nurse, who was known to be sympathetic to euthanasia, had administered the lethal dose of medication to Mr. Parker. The nurse was immediately terminated from her position and reported to the authorities.
Through the investigation, it was also discovered that Mr. Parker had been researching euthanasia and had found a group that supported the practice. It was suspected that he may have coerced the nurse into performing the procedure.
Dr. Sanders was deeply troubled by the incident and was left questioning her own actions. She wondered if she could have done more to alleviate Mr. Parker’s suffering and prevent this tragic outcome.
After the investigation, the hospital implemented new policies and procedures to prevent future incidents of this nature. Dr. Sanders became a vocal advocate for palliative care and the importance of supporting patients in their end-of-life journey. She also made a point to educate her colleagues on the ethical implications of euthanasia and the role of practitioners in providing compassionate care.
The case of Mr. Parker serves as a stark reminder of the importance of upholding the principles of beneficence and nonmaleficence in medical practice. It also highlights the need for open and honest communication between patients and practitioners, particularly in situations where patients may be experiencing intolerable suffering.
Abstract
Euthanasia, meaning “good death” in Greek, is the administration of a lethal agent by another person to relieve a patient’s incurable and intolerable suffering. The American Medical Association’s (AMA) Code of Medical Ethics considers euthanasia to be incompatible with the role of a physician as a healer and states it would cause more harm than good. The American College of Physicians (ACP) also does not support physician-assisted suicide or euthanasia. Although some states have legalized practitioner-assisted death, also known as “death with dignity,” the medical profession has made it clear that euthanasia is never permissible for a practitioner to engage in. The medical profession recommends palliative care and a supportive patient environment instead of euthanasia to control a patient’s pain and suffering.
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Think
[17:1] Etymologically the term euthanasia comes from the Greek ‘Eu’ meaning ‘good’ and ‘Thanatos’ meaning ‘death.’ Euthanasia means ‘good death.’
[17:2] The American Medical Association (AMA) Code of Medical Ethics 5.8 defines euthanasia as:
The administration of a lethal agent by another person to a patient for the purpose of relieving the patient’s intolerable and incurable suffering.
[17:3] However, there is an incontrovertible contradiction between the role and function of euthanasia with the role and function of the medical profession. Euthanasia is the ‘art of dying,’ whereas medicine is the ‘art of healing.’ Rationally, the art of healing together with the art of dying is a logical contradiction. Empirically, it is argued that the medical practice of euthanasia would negatively affect the patient-practitioner relationship and the public perception of the medical profession.
[17:4] The American Medical Association (AMA) Code of Medical Ethics 5.8 concludes:
Permitting physicians [practitioners] to engage in euthanasia would ultimately cause more harm than good. Euthanasia is fundamentally incompatible with the physician’s [physician’s] role as healer, would be difficult or impossible to control, and would pose serious societal risks.
[17:5] The American College of Physicians (ACP) Ethics Manual states:
The College does not support the legalization of physician [practitioner]-assisted suicide or euthanasia. After much consideration, the College concluded that making physician [practitioner]-assisted suicide legal raised serious ethical, clinical, and social concerns.
[17:6] Because of rational incoherence and the possible harmful consequences, the medical practice of euthanasia has been determined to be professionally unaccepted.
Assess
Patient: 1) Autonomy
[17:7] If a patient has autonomously chosen to be euthanized, then it is understandable that the patient would want their practitioner to do the euthanizing. From the patient’s perspective, the practitioner would know the best method for euthanization and have the best skills for delivering the method to the patient without error.
[17:8] The autonomous informed consent process is a collaborative or joint decision-making process, in that the diagnosis, prognosis, treatment options, information of risks and benefits, and the answering of patient’s questions are provided by the practitioner to aid the patient in the making of an autonomous informed consent decision for authorizing the practitioner to provide treatment. In other words, the treatment options offered by the practitioner to the patient will only be those options that are medical standards of care. Futile treatments and treatments not professionally accepted are not options for authorization. Euthanasia is not within the medical standards of care, and therefore there can be no patient authorization of a treatment option that will not be provided.
Practitioner: 2) Beneficence & 3) Nonmaleficence
[17:9] However, regardless of whether or not the patient autonomously chooses to be euthanized or whether or not euthanasia is legal or not, those facts do not determine if practitioners ought to be permitted by the medical profession to be engaged in euthanasia. For example, capital punishment is legal and enforced in 27 states, yet the medical profession still forbids practitioners from participating in the killing of a convicted prisoner because of the logical contradictions and harmful consequences. Euthanasia, in like fashion, even were it to become legal in some states, would not mean that it would become professionally permissible for practitioners to participate or provide assistance.
[17:10] If it is rationally true that euthanasia and the art of medicine together result in a logical contradiction, such as being both a healing art and dying art, and if euthanasia would result in unacceptable harmful consequences, such as violating the patient-practitioner relationship or diminish the public’s trust of the medical profession, then it would be reasonable for the medical profession to forbid practitioners from such activities, even if the practitioner were to personally or individually believe in its legal and moral permissibility.
Public Policy: 4) Justice
[17:11] Practitioner-assisted death, or death with dignity, is defined as the practitioner providing the patient with the knowledge or means of ending their own life voluntarily.
[17:12] Euthanasia differs from practitioner-assisted death. With assisted death, the patient is the one who takes the medicine or administers the method that results in death, whereas with euthanasia, the individual does not directly end their own life. Instead another person acts to cause the individual’s death. Because of this distinction, euthanasia is illegal throughout the United States. However, euthanasia is legal in Belgium, Canada, Luxembourg, Netherlands, New Zealand, Spain, and several states of Australia.
[17:13] Death with dignity, also known as assisted death, is legal in eleven U.S. jurisdictions: California, Colorado, District of Columbia, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont, and Washington.
Conclude
[17:15] In the United States, the medical profession has made it clear that euthanasia is never permissible for a practitioner to engage in, even if it were to become legal. If the practitioner is having difficulty in controlling a patient’s pain and suffering, then they need to seek out a palliative care consultation while providing a supportive and caring patient environment.
[17:16] In summary, the medical profession in the United States strongly opposes euthanasia, even if it becomes legal. The focus should be on providing palliative care and a compassionate patient environment to manage pain and suffering. Upholding the role of a practitioner as a healer is essential in maintaining trust and the integrity of the patient-practitioner relationship, as well as preserving the medical profession’s commitment to the principles of beneficence and nonmaleficence.
(See also: 5. Assisted Suicide, 6. Capital Punishment - Executions, 11. Death With Dignity - Practitioner-Assisted Dying, 27. Interrogations, and 58. Torture)
**
17. Review Questions
1. Euthanasia comes from the Greek meaning.
2. Both the AMA and the ACP will allow euthanasia but only under very restricted conditions.
3. In the states where euthanasia is legal, it becomes professionally permissible for practitioners to participate under strict limitations.
4. Treatment options offered by the practitioner to the patient are those that meet medical standards of care. Futile treatments and treatments not professionally accepted are not options for patient authorization.
5. With practitioner-assisted death, or death with dignity, the practitioner is the one who administers the method that results in death.
**
CORRECT! 🙂
[17:1] Etymologically the term euthanasia comes from the Greek ‘Eu’ meaning ‘good’ and ‘Thanatos’ meaning ‘death.’ Euthanasia means ‘good death.’
Wrong 😕
[17:1] Etymologically the term euthanasia comes from the Greek ‘Eu’ meaning ‘good’ and ‘Thanatos’ meaning ‘death.’ Euthanasia means ‘good death.’
CORRECT! 🙂
[17:4] The AMA Code of Medical Ethics 5.8 concludes:
Permitting physicians [practitioners] to engage in euthanasia would ultimately cause more harm than good. Euthanasia is fundamentally incompatible with the physician’s [practitioner’s] role as healer, would be difficult or impossible to control, and would pose serious societal risks.
[17:5] The American College of Physicians (ACP) Ethics Manual states:
The College does not support the legalization of physician [practitioner]-assisted suicide or euthanasia. After much consideration, the College concluded that making physician [practitioner]-assisted suicide legal raised serious ethical, clinical, and social concerns.
Wrong 😕
[17:4] The AMA Code of Medical Ethics 5.8 concludes:
Permitting physicians [practitioners] to engage in euthanasia would ultimately cause more harm than good. Euthanasia is fundamentally incompatible with the physician’s [practitioner’s] role as healer, would be difficult or impossible to control, and would pose serious societal risks.
[17:5] The American College of Physicians (ACP) Ethics Manual states:
The College does not support the legalization of physician [practitioner]-assisted suicide or euthanasia. After much consideration, the College concluded that making physician [practitioner]-assisted suicide legal raised serious ethical, clinical, and social concerns.
CORRECT! 🙂
[17:4] The AMA Code of Medical Ethics 5.8 concludes:
Permitting physicians [practitioners] to engage in euthanasia would ultimately cause more harm than good. Euthanasia is fundamentally incompatible with the physician’s [practitioner’s] role as healer, would be difficult or impossible to control, and would pose serious societal risks.
[17:5] The American College of Physicians (ACP) Ethics Manual states:
The College does not support the legalization of physician [practitioner]-assisted suicide or euthanasia. After much consideration, the College concluded that making physician [practitioner]-assisted suicide legal raised serious ethical, clinical, and social concerns.
Wrong 😕
[17:4] The AMA Code of Medical Ethics 5.8 concludes:
Permitting physicians [practitioners] to engage in euthanasia would ultimately cause more harm than good. Euthanasia is fundamentally incompatible with the physician’s [practitioner’s] role as healer, would be difficult or impossible to control, and would pose serious societal risks.
[17:5] The American College of Physicians (ACP) Ethics Manual states:
The College does not support the legalization of physician [practitioner]-assisted suicide or euthanasia. After much consideration, the College concluded that making physician [practitioner]-assisted suicide legal raised serious ethical, clinical, and social concerns.
CORRECT! 🙂
[17:8] The autonomous informed consent process is a collaborative or joint decision-making process, in that the diagnosis, prognosis, treatment options, information of risks and benefits, and the answering of patient’s questions are provided by the practitioner to aid the patient in the making of an autonomous informed consent decision for authorizing the practitioner to provide treatment. In other words, the treatment options offered by the practitioner to the patient will only be those options that are medical standards of care. Futile treatments and treatments not professionally accepted are not options for authorization. Euthanasia is not a medical standard of care, and therefore there can be no patient authorization of a treatment option that will not be provided.
Wrong 😕
[17:8] The autonomous informed consent process is a collaborative or joint decision-making process, in that the diagnosis, prognosis, treatment options, information of risks and benefits, and the answering of patient’s questions are provided by the practitioner to aid the patient in the making of an autonomous informed consent decision for authorizing the practitioner to provide treatment. In other words, the treatment options offered by the practitioner to the patient will only be those options that are medical standards of care. Futile treatments and treatments not professionally accepted are not options for authorization. Euthanasia is not a medical standard of care, and therefore there can be no patient authorization of a treatment option that will not be provided.
CORRECT! 🙂
[17:11] Practitioner-assisted death, or death with dignity, is defined as the practitioner providing the patient with the knowledge or means of ending their own life voluntarily.
[17:12] Euthanasia differs from practitioner-assisted death. With assisted death, the patient is the one who takes the medicine or administers the method that results in death. Whereas with euthanasia, the individual does not directly end their life, instead another person acts to cause the individual’s death. Because of this distinction, euthanasia is illegal throughout the United States. However, euthanasia is legal in Belgium, Canada, Luxembourg, Netherlands, New Zealand, Spain, and several states of Australia.
Wrong 😕
[17:11] Practitioner-assisted death, or death with dignity, is defined as the practitioner providing the patient with the knowledge or means of ending their own life voluntarily.
[17:12] Euthanasia differs from practitioner-assisted death. With assisted death, the patient is the one who takes the medicine or administers the method that results in death. Whereas with euthanasia, the individual does not directly end their life, instead another person acts to cause the individual’s death. Because of this distinction, euthanasia is illegal throughout the United States. However, euthanasia is legal in Belgium, Canada, Luxembourg, Netherlands, New Zealand, Spain, and several states of Australia.
17. Clinical Vignettes
1. Ms. Matilda Patel, an 82-year-old retiree has been diagnosed with a debilitating illness and is experiencing incurable and intolerable suffering. The patient is requesting euthanasia as a means to end their suffering. Which actions would be considered the most ethical for a practitioner to take?
2. Mr. Nathaniel Thomas, a 78-year-old retiree with end-stage cancer presents with unrelenting pain and suffering to the practitioner. The patient requests the practitioner to assist in ending their life peacefully. Which actions are considered most ethical according to the AMA and ACP guidelines?
3. Ms. Claire Allen, a 92-year-old retiree suffers from a terminal illness with no chance of recovery and is experiencing significant pain and suffering. The patient's family is seeking assistance in ending their loved one's life. The practitioner is conflicted about what to do and turns to the American Medical Association (AMA) and the American College of Physicians (ACP) for guidance. This scenario occurs in a state where euthanasia is legal and under strict limitations. Which of the following actions aligns with the ethical principles established by the AMA and ACP in the context of euthanasia or assisted suicide?
4. Ms. Mariah Phillips, a 54-year-old meteorologist presents to the practitioner with a terminal illness and seeks treatment options. The practitioner explains to the patient that they can only offer treatments that meet medical standards of care and that futile treatments and treatments not professionally accepted are not options for patient authorization. Which treatments would the practitioner be ethically and professionally able to offer the patient?
5. Mr. Leonardo Wright, a 78-year-old retiree with a terminal illness is seeking a peaceful and dignified death. The patient asks the practitioner for assistance in ending their life. The practitioner explains that with practitioner-assisted death, or death with dignity, they are not the one who administers the method that results in death, but rather they will only provide the patient with a lethal prescription, which is to be taken by the patient. Although it is professionally questionable for practitioners to engage in practitioner-assisted death or death with dignity, it is an option that some patients may choose in the face of terminal illness and unbearable suffering. Which of the following actions would align with the concept of practitioner-assisted death or death with dignity?
CORRECT! 🙂
Explanation: The most ethical action for a practitioner to take in this situation is, explaining to the patient that euthanasia is not a permissible option [17:4] and offering alternative forms of pain management and end-of-life care. Euthanasia, or intentionally ending a patient's life, is illegal in most jurisdictions and is considered ethically and morally controversial [17:2]. Healthcare providers have a responsibility to provide the best possible care to their patients, which includes providing comfort care and pain management [17:5], but not intentionally ending a patient's life. Administering a lethal agent to end the patient's suffering, is not ethical as it violates the principles of medical ethics, which prohibit intentional killing or harm to patients [17:3]. Referring the patient to a practitioner who will assist with euthanasia, is also not ethical as it can be seen as an endorsement of euthanasia and can put the practitioner at risk of legal and ethical violations. Ignoring the patient's request and not discussing the option of euthanasia, is not ethical as it fails to address the patient's concerns and needs and can lead to further suffering.
Wrong 😕
Explanation: The most ethical action for a practitioner to take in this situation is, explaining to the patient that euthanasia is not a permissible option [17:4] and offering alternative forms of pain management and end-of-life care. Euthanasia, or intentionally ending a patient's life, is illegal in most jurisdictions and is considered ethically and morally controversial [17:2]. Healthcare providers have a responsibility to provide the best possible care to their patients, which includes providing comfort care and pain management [17:5], but not intentionally ending a patient's life. Administering a lethal agent to end the patient's suffering, is not ethical as it violates the principles of medical ethics, which prohibit intentional killing or harm to patients [17:3]. Referring the patient to a practitioner who will assist with euthanasia, is also not ethical as it can be seen as an endorsement of euthanasia and can put the practitioner at risk of legal and ethical violations. Ignoring the patient's request and not discussing the option of euthanasia, is not ethical as it fails to address the patient's concerns and needs and can lead to further suffering.
CORRECT! 🙂
Explanation: The practitioner should alleviate the patient's physical symptoms while addressing their psychological and personal needs through palliative care [17:4][17:13]. This involves providing comfort care and pain management while addressing the patient's emotional, spiritual, and social needs [17:4]. Palliative care aims to improve the quality of life for patients with serious illnesses, and does not intentionally end the patient's life [17:4]. Complying with the patient's request and assisting in ending their life, is not ethical as it violates the principles of medical ethics, which prohibit intentional killing or harm to patients [17:2][17:4]. Referring the patient to another practitioner who may assist in ending their life, is also not ethical as it can be seen as an endorsement of euthanasia and can put the practitioner at risk of legal and ethical violations [17:4]. Offering the patient a sedative may be appropriate in some situations, but it is not the primary approach recommended by the AMA and ACP guidelines [17:4]. The most ethical action for the practitioner to take in this situation is to provide palliative care, which involves alleviating the patient's physical symptoms while addressing their psychological and personal needs [17:4][17:13]. This approach is consistent with the principles of medical ethics and provides the best possible care for the patient while respecting their dignity and autonomy [17:4].
Wrong 😕
Explanation: The practitioner should alleviate the patient's physical symptoms while addressing their psychological and personal needs through palliative care [17:4][17:13]. This involves providing comfort care and pain management while addressing the patient's emotional, spiritual, and social needs [17:4]. Palliative care aims to improve the quality of life for patients with serious illnesses, and does not intentionally end the patient's life [17:4]. Complying with the patient's request and assisting in ending their life, is not ethical as it violates the principles of medical ethics, which prohibit intentional killing or harm to patients [17:2][17:4]. Referring the patient to another practitioner who may assist in ending their life, is also not ethical as it can be seen as an endorsement of euthanasia and can put the practitioner at risk of legal and ethical violations [17:4]. Offering the patient a sedative may be appropriate in some situations, but it is not the primary approach recommended by the AMA and ACP guidelines [17:4]. The most ethical action for the practitioner to take in this situation is to provide palliative care, which involves alleviating the patient's physical symptoms while addressing their psychological and personal needs [17:4][17:13]. This approach is consistent with the principles of medical ethics and provides the best possible care for the patient while respecting their dignity and autonomy [17:4].
CORRECT! 🙂
Explanation: The practitioner should provide palliative care of comfort and support to the patient and the family, but decline to participate in any form of euthanasia or assisted suicide. The American Medical Association (AMA) and the American College of Physicians (ACP) prohibit intentional killing or harm to patients [17:4], and the practitioner's primary responsibility is to provide compassionate care and alleviate the patient's pain and suffering. In a state where euthanasia is legal, the AMA and ACP oppose these practices, even under strict limitations [17:5]. The practitioner should discuss the patient's prognosis and treatment options, including palliative care and hospice care, with the patient and the family [17:1], and provide emotional support and counseling to the patient and the family during this difficult time. Referring the patient to another practitioner who is known to participate in euthanasia or assisted suicide [17:10] or providing the patient with information about how to obtain a lethal dose of medication, but declining to participate in the administration of the medication [17:4], can be seen as a tacit endorsement of euthanasia and can put the practitioner at risk of legal and ethical violations.
Wrong 😕
Explanation: The practitioner should provide palliative care of comfort and support to the patient and the family, but decline to participate in any form of euthanasia or assisted suicide. The American Medical Association (AMA) and the American College of Physicians (ACP) prohibit intentional killing or harm to patients [17:4], and the practitioner's primary responsibility is to provide compassionate care and alleviate the patient's pain and suffering. In a state where euthanasia is legal, the AMA and ACP oppose these practices, even under strict limitations [17:5]. The practitioner should discuss the patient's prognosis and treatment options, including palliative care and hospice care, with the patient and the family [17:1], and provide emotional support and counseling to the patient and the family during this difficult time. Referring the patient to another practitioner who is known to participate in euthanasia or assisted suicide [17:10] or providing the patient with information about how to obtain a lethal dose of medication, but declining to participate in the administration of the medication [17:4], can be seen as a tacit endorsement of euthanasia and can put the practitioner at risk of legal and ethical violations.
CORRECT! 🙂
Explanation: The practitioner can ethically and professionally offer the patient treatments that are in line with established medical standards of care and are effective for the patient's condition [17:2]. The ethical principle of beneficence requires that the practitioner act in the best interest of the patient and provide treatments that will benefit the patient [17:4]. In addition, the principle of nonmaleficence requires that the practitioner avoid harm to the patient and not provide treatments that have significant adverse effects or are futile [17:4]. Treatments that have not been scientifically tested and lack evidence of efficacy, treatments that are ineffective in treating the patient's condition, and treatments that are considered experimental and have not been widely adopted by the medical community are not options that meet medical standards of care and are not ethically or professionally appropriate for the practitioner to offer to the patient [17:6].
Wrong 😕
Explanation: The practitioner can ethically and professionally offer the patient treatments that are in line with established medical standards of care and are effective for the patient's condition [17:2]. The ethical principle of beneficence requires that the practitioner act in the best interest of the patient and provide treatments that will benefit the patient [17:4]. In addition, the principle of nonmaleficence requires that the practitioner avoid harm to the patient and not provide treatments that have significant adverse effects or are futile [17:4]. Treatments that have not been scientifically tested and lack evidence of efficacy, treatments that are ineffective in treating the patient's condition, and treatments that are considered experimental and have not been widely adopted by the medical community are not options that meet medical standards of care and are not ethically or professionally appropriate for the practitioner to offer to the patient [17:6].
CORRECT! 🙂
Explanation: The practitioner who participates in practitioner-assisted death or death with dignity would provide the patient with a prescription for a lethal dose of medication and instruct the patient on how to self-administer the medication [17:11]. In this scenario, the practitioner is not the one who administers the method that results in death, but only provides the patient with the means to end their life. Although it is professionally questionable for practitioners to engage in practitioner-assisted death or death with dignity [17:5], it is an option that some patients may choose in the face of terminal illness and unbearable suffering. Providing the patient with a prescription for a lethal dose of medication and instructing them on how to self-administer it aligns with the concept of practitioner-assisted death or death with dignity [17:11]. The practitioner agrees to provide the patient with a means to end their life, but the patient takes the final action. The other options - administering the medication, engaging in end-of-life care but declining to participate in practitioner-assisted death or referring the patient to a support organization - are not considered to be practitioner-assisted death or death with dignity.
Wrong 😕
Explanation: The practitioner who participates in practitioner-assisted death or death with dignity would provide the patient with a prescription for a lethal dose of medication and instruct the patient on how to self-administer the medication [17:11]. In this scenario, the practitioner is not the one who administers the method that results in death, but only provides the patient with the means to end their life. Although it is professionally questionable for practitioners to engage in practitioner-assisted death or death with dignity [17:5], it is an option that some patients may choose in the face of terminal illness and unbearable suffering. Providing the patient with a prescription for a lethal dose of medication and instructing them on how to self-administer it aligns with the concept of practitioner-assisted death or death with dignity [17:11]. The practitioner agrees to provide the patient with a means to end their life, but the patient takes the final action. The other options - administering the medication, engaging in end-of-life care but declining to participate in practitioner-assisted death or referring the patient to a support organization - are not considered to be practitioner-assisted death or death with dignity.
**
17. Reflection Vignettes
1. Mr. David Brown, a 60-year-old retired teacher, is currently in the ICU with symptoms of a terminal illness, including severe pain and suffering. Despite the best efforts of the attending practitioner to manage his symptoms, Mr. Brown's condition has continued to deteriorate. He has decisional capacity and requests that the practitioner perform euthanasia, citing his unacceptable levels of pain and suffering and a lack of joyful life prospects. The differential diagnosis for Mr. Brown's symptoms could include conditions such as cancer, end-stage renal disease, or advanced heart failure. However, in this case, Mr. Brown's request for euthanasia is based on his perception of his quality of life and suffering, rather than any specific medical diagnosis.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
**
2. Ms. Rachel Lee, a 55-year-old lawyer, is currently in the ICU with a terminal illness, and her condition has continued to worsen despite aggressive medical intervention. Ms. Lee has decisional capacity and requests that the practitioner perform euthanasia, arguing that there is no moral difference between having the right to end her life by having someone withdraw life-sustaining treatment than having someone administer a lethal dose. Both actions are equal in that they each require someone else to do something, and both actions result in the patient's death. The differential diagnosis for Ms. Lee's symptoms could include conditions such as advanced cancer, end-stage organ failure, or a degenerative neurological disorder. However, in this case, Ms. Lee's request for euthanasia is based on her perception of her quality of life and the belief that her suffering is intolerable.
Think
Assess
Patient: Autonomy
Practitioner: Beneficence & Nonmaleficence
Public Policy: Justice
Conclude
***
