Mrs. Smith was diagnosed with dementia several years ago. Over the course of the last year, her dementia has progressed to the point where she is no longer able to care for herself.

Her doctor has certified her as eligible for hospice and her family has agreed to bring in hospice to help make her comfortable in her last days.

Mrs. Smith does well with her hospice care for the first few weeks but has been in a considerable amount of pain and has become increasingly agitated. She has started refusing to eat, and drinks very little as she says food and drink makes her feel worse.

She verbalizes daily her lack of desire to live any longer in such a state and recently asked the hospice physician for a lethal dose of her pain medications so "she can die peacefully in her sleep and finally be rid of all the pain she feels".

The hospice doctor is torn as she considers Mrs. Smith's request for the lethal dose of pain medications.

She sees the amount of pain Mrs. Smith is in, but also know there are laws and ethical principles to consider and follow. If you were the hospice physician, what would you do and why?

For purposes of this discussion, please assume that Mrs. Smith does NOT live in state such as Oregon where the law allows for physician assisted death.