Do you believe that the decision to treat Maria with IV morphine 6 months earlier was to hasten her death? Is this an “acceptable” outcome for someone who is 94 years old and in hospice care, or do you feel that the decision was unethical? Can the decision be justified based on the fact that an increasing number of people with chronic, nontreatable diseases are living longer, raising the cost of medical care and drawing on restricted resources which may otherwise be available for those who are “not as bad?”
B. Dan.
Dan wants to die, but his doctors and the ethics committee at a hospital to which he was recently admitted for treatment of pneumonia does not support his decision. Dan is 32 years old, totally paralyzed from the neck down, and has been respirator-dependent since the age of 3. A car accident had caused severe and irreversible damage to the spinal cord in his neck. Dan cannot remember life without a respirator. Even when he dreams, he sees himself as totally helpless and dependent on his caregivers for all his activities of daily living. It drives him insane when he has an itch and there is no one around to scratch it. His mother inserts a catheter through his penis several times a day to empty his bladder. He has no control over his bowels. However, he can see, talk, and take food by mouth. Most importantly, he can think, but thinking has become his worst enemy. He spends a lot of his time thinking about the state of his life—where his life is heading and the quality of that life. He feels trapped in his body, 24 hours a day, 7 days a week.
He wants to die, but his physicians and the ethics committee will not support his decision. His mother supports his decision, but his father (divorced when Dan was 5 years old) does not agree, citing his own faith for that reasoning.
A part of a video interview (Video 39.2) with Dan is attached. What ethical decision would you arrive at, and how would you justify that decision? 
• Exploring ethical considerations in the 21st century:
• ethical theories on which to base your practical judgments
• ethical considerations for patients with altered mental status, or in coma or the vegetative state
• Examining important elements of informed consent, including comprehension, decision-making capacity, full disclosure of risks and benefits, and the ability to grant, withhold, or withdraw consent.
• Approaching brain death from clinical, ethical, and legal standpoints.
• Exploring moral and ethical issues related to advances in genetic testing, gene and stem cell therapy.
• Examining end-of-life situations.
• Understanding the ethical implications of the long and symbiotic relationship that exists between the medical profession and the drug industry.
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