Clinical scenarios
| SCENARIO NO. | CLINICAL PRACTICES | SCENARIO | |
|---|---|---|---|
| 1 | Withdrawal of potentially life-prolonging treatment | A 75-year-old patient is suffering from a terminal pulmonary disease. She was transferred to an intensive care unit and intubated after acute respiratory distress. She has been on mechanical ventilation for a week. In writing, the patient asks her physician for aid in dying, and to stop the ventilator. With the physician’s prescription, mechanical ventilation is withdrawn and the nurse starts an intravenous midazolam infusion adjusted for respiratory symptom relief. The patient dies within an hour | |
| 2 | Use of medication adjusted to symptom relief | A 75-year-old patient is suffering from metastatic and incurable lung cancer. She is having pain that is causing suffering that she considers intolerable. The patient asks her physician for aid in dying. With the physician’s prescription, morphine is gradually increased until the patient’s symptoms are relieved. The patient dies the next day | |
| 3 | Use of potentially lethal medication above what is needed for symptom relief • administered by the patient (oral barbiturates) | A 75-year-old patient is suffering from metastatic and incurable lung cancer. | With the physician’s prescription, the nurse provides her with a bottle of high-dose barbiturates (eg, thiopental). The patient takes the medication and dies 3 hours later |
| 4 | • administered by the health care professional (intravenous opioids above what is needed for symptom relief) | The pain is relieved with morphine, but she is suffering from increasing tiredness and difficulties with everyday activities at home. She does not want to be a burden to her family and believes that her condition causes her intolerable suffering. The patient asks her physician for aid in dying | With the physician’s prescription, the nurse administers 100 mg of morphine intravenously, doubling the dose with each injection, even after the patient becomes unconscious. The patient dies a few hours later |
| 5 | • administered by the health care professional (barbiturates and a neuromuscular blocking agent) | With the physician’s prescription, the nurse administers barbiturates (eg, thiopental) intravenously and, after the patient becomes unconscious, injects a neuromuscular blocking agent (eg, pancuronium) that paralyzes muscles, including respiratory ones. The patient stops breathing and death is certified a few minutes later | |
| 6 | • administered by the health care professional upon a relative’s request (barbiturates and a neuromuscular blocking agent) | A 75-year-old patient is suffering from metastatic and incurable lung cancer. She has been unconscious for a few days. The patient did not request medical aid in dying from her physician. The patient’s representative (her son) asks the physician for aid in dying because his mother would not have wanted to live like this. He considers his mother’s suffering intolerable and that it would be unacceptable to prolong her agony. With the physician’s prescription, the nurse administers barbiturates (eg, thiopental) intravenously and, after the patient becomes unconscious, injects a neuromuscular blocking agent (eg, pancuronium) that paralyzes muscles, including respiratory ones. The patient stops breathing and death is certified a few minutes later | |