Question analysis and exploration

Palliative care is defined as care which will improve the quality of life for a patient and the patient's family when they face life threatening illness. Palliative care provides prevention and relief of suffering on the part of the patient. It includes the identification of discomfort, the treatment of pain and the support of the patient and families in the physical, psychosocial and spiritual spheres. By definition, palliative care will neither hasten or postpones death, but rather makes the attempt to approach death as a normal process, allowing the patient to live as actively and maintain as much control as possible until death occurs. In Will's case, the administration of palliative care, by definition, cannot include the administration of the morphine at such a dose to hasten his death. This would be defined as euthanasia, which Will is requesting by the administration of the morphine. Were Will still able to administer the medication on his own, via activation of his PCA pump, then the act would be considered passive euthanasia since the likelihood is that the dose of the medication will suppress Will's respiratory drive rather than simply treat his pain. The administration of morphine in such doses is considered ethical in most political jurisdictions, and by most medical societies. In Will's case, should the physician administer the medication in such a dose as to suppress Will's respiratory drive, the motive for the physician would be one of mercy. The difference between this and physician assisted suicide is the intent behind the act. Physician assisted suicide is not legal in most states, and the intent behind this act is to allow the patient to end his or her own life. In Will's case, the physician may hasten death but the primary reason for the administration of the medication is to alleviate Will's severe pain and suffering. In this case, palliative care may in effect hasten Will's death, but that will not be the primary reason for the administration of his morphine. Ethically and legally, this poses no problem for either the hospice personnel or the physician who manages his care. Will's desire to withdrawal all life support and refuse his treatment is supported by legal precedent, even though it is likely that his refusal of treatment will result in his death. Conversely, Will does not have the legal right to demand treatment or intervention which would hasten his death. Therefore, were Will placed on life support, and it was known that his desire was not to have such support given to him, then this could be withdrawn. There is a catch-22 situation in the Supreme Court has found that while laws which prohibit physician assisted suicide are not considered unconstitutional, laws permitting physician assisted suicide are not unconstitutional. The withdrawal of intervention on Will's part is based on the assumption that Will's request for the removal of intervention is a rational one, in light of his illness, his pain and his desire to avoid becoming a burden to his family and experience a death like his mother had. For a physician to administer pain medication and hold intervention, this simply represents the physician's duty to treat Will's illness in every way possible, even to treat his imminent death. By supporting Will's wishes to remove intrusive medical treatment, there is support for social factors which Will made clear early on in his illness. The decision does not lie with his wife alone, although she has the power of attorney; she can go by Will's wishes as they were made known before he was rendered incapable of speech. Will has been able to maintain an open dialogue with his family and his physicians, and it is likely that he was relatively rational in his ability to communicate his final wishes with his physician. The physician will need to be sure that he has assessed Will for vulnerability to thoughts of suicide or other issues which would be amenable to palliative care. It appears that this is not the case for Will.