End of Life Case Study

Will Huckabee, 50, is dying of cancer. When he was first diagnosed with liver cancer it had already begun to metastasize to other organs, but Will was eager to fight off the disease and live with as high a quality of life as possible. Over time, however, his upbeat attitude changed. As he became weaker and endured more pain, Will lost his early hope of maintaining a satisfying quality of life. Instead, he became increasingly anxious that his condition would become unbearable.

At first, Will's pain was controlled by oral morphine. Within a period of months, however, he required stronger palliative care (pain relief); although he remained at home with his wife, his use of a self-administered morphine pump only postponed the looming crisis brought about by his increasing struggle to control his own pain. Moreover, because a heavy dose of morphine was required, it left Will weak and drug-dependent, but it did not completely relieve his pain.

Will's doctors explained that as his cancer spread and he became sicker, many of his organ functions would decline. Although aggressive surgical and medical treatments could support his organs and extend his life, Will decided to forego these procedures and explained that he no longer wished to undergo invasive procedures with difficult side effects.

Will also made a request that caused considerable turmoil among his physicians and members of his family. He asked that his morphine pump be programmed so that it could administer a lethal dose at the point when Will decided that living with his disease had become intolerable. As he discussed his request with his friends, family, and doctors, he continually stressed his intense wish to avoid the horrors endured by his mother, who had endured a slow death by breast cancer.

Will's family had mixed feelings about his request. Although his two children were largely supportive, his wife Gloria was more ambivalent: she explained to Will that she could not bear to watch him undergo a prolonged period of even greater suffering, but she also did not want to choose a path that would hasten his death. Gloria had become exhausted while caring for Will, and she found it extremely difficult and stressful to discuss this topic with him.

Before Gloria and Will could resolve their differences, Will faced another setback: a stroke, which left him unable to communicate clearly, either orally or in writing, and which probably caused some degree of cognitive impairment. In time, his doctors believed, intensive rehabilitative therapy could help Will to regain the power to communicate. Unfortunately, Will possessed neither the time nor energy to undergo that course of therapy. Although he could no longer actively make decisions about his own healthcare, Will's anguished cries of pain wrenched at the hearts of those around him.

At the start of his illness, Will had appointed Gloria to be his surrogate health care decision-maker in case he became unable to make decisions for himself, and he also executed a legally valid medical power of attorney affirming this decision. As Gloria is deciding what to do, she tries to understand whether it would have been ethical for his doctors to agree to his earlier request had Will not had the stroke. She also struggles to understand what difference his stroke makes, and whether suffering that indignity makes it right for her to substitute her own judgment for his expressed wishes.

In your discussion post, answer the following questions supported by ethical reasoning and theory:

• Is Will's request to reprogram the morphine machine justified by an ethical right to decide the course of his own death?
• Should a law be passed making it legal for physicians to honor requests like Will's to have his morphine pump reprogrammed?

In addition to your posted answer, be sure to comment on at least two of your classmates' post and participate regularly. Responses to others can come in many forms and can include the following:

• Responding to the ideas or details of someone else's responses.
• Taking a concept from the reading and applying it to life, to the reading itself, to your work, or to the questions you're asked to answer.
• Helping a peer understand a concept from the reading.
• Sharing a story from work or your community that illustrates the reading.
• Asking questions on points you need help understanding.
• Explaining why you answered a question in a specific way.
• Pointing out how different answers took the question in different directions/noting a pattern/suggesting an explanation.
• Developing theories to explain patterns you see in the reading.
• Summarizing aspects of the assigned reading and asking for help from your peers in figuring out how you would apply this concept in a real world situation.