Role Playing Exercise: A Case of Killing vs Letting Die

What does one do when a patient who has the mental capacity to make medical decision requests a physician to turn off a life-supportive treatment knowing that the act will lead to the patient’s death. One of the ethical issues is whether that act represents intentional killing of the patient or not killing but simply allowing the patient to die from the underlying illness. In this case example of the issue, you will be role-playing the physician. ..Maurice.



Mr. G. is a 34 year old unmarried man who has been a quadriplegic (unable to breathe without the respirator and unable to move his arms or legs) for the past 4 years since he was injured in a motorcycle accident. You, as the newly appointed physical therapy physician in a neurologic rehabilitation hospital have met and examined Mr. G. for the first time. He can talk during the respirator phase when he is exhaling and tells you his history. For most of the 4 years, the patient lives alone at home except for a full-time male aide who attends to his comfort, nursing care and feeding. During this time he was hospitalized about 5 times, twice for pneumonia and a few times for severe urinary tract infections which led to infection in the blood stream and required intensive intravenous antibiotics. This admission was a few days before you arrived and was for another urinary tract infection, now being treated and his fever is abated.

Mr. G. states that he was a city motorcycle officer for 8 years prior to his accident and had a girl friend whom he was hoping to marry living with him for the year before the accident. He speaks sadly about the fact that his girl friend left him shortly after he became quadriplegic and has not returned. Though at first he had understood he had a slim chance for some recovery, he states after additional tests that doctors told him that his spinal cord was completely severed and there can be no return of function. He says he has been evaluated by physical therapists numerous times in the past and has had whatever support and encouragement that they could provide but he has continued in an immobile state, spending most of his life of a quadriplegic in bed. The few hours the aide gets him up in a chair causes him to be exhausted easily. He finds his quality of life so poor that in the past year, he has decided that he no longer wants to live. He knows that if he could turn off the respirator, he would die fairly quickly but he is physically unable to perform the act himself. He has asked his aide to turn off the respirator so he could die. The aide refused. On two previous hospital admissions, he had asked the physicians in the hospital to turn off the respirator, but they too refused. He has been given anti-depressants in the past but they have not changed his demands to end his life.

Mr. G. now turns to you, as his new physician, and after relating his life story, he requests that you turn off the respirator and let his underlying illness cause him to die. As you talk to Mr. G., you evaluate his mental state you find that he is mentally clear and his understanding of the medical facts of his illness and the consequences of his request is excellent. You understand that every patient has the autonomous right to refuse unwanted treatment and to force treatment on a patient who has capacity to make medical decisions may even represent legal battery.

Mr. G. says to you “Doctor, I no longer want to live the way I have been living these past 4 years so now I want you to turn off the ventilator and allow me to die a natural death.” OK.. now you as Mr. G.’s physician must decide what to do next. …. Well, Mr. G. is waiting for your response. You can write the response in the Comment section of this posting.

(For your information, this has been a altered description of a real case. Some of the facts may be a bit different but the issue and ethical challenge is the same as the original case.)