CASE 1 FOR ETHICAL DECISION MAKING:

Miss. S is a 67-year-old retired teacher. She has never married and has no children or living siblings. Her closest
relatives are several nieces and nephews, whom she has seen intermittently over the years. Since her retirement,
Miss S. lived with Ana, a very distant female relative for companion who is also studying a caregiving course. She
is independent and lives frugally, yet comfortably.

One evening while alone in the house, Miss S stumbled and fell backward on her porch, hitting the back of her
head. She felt weak all over and experienced tingling in her arms and hands, but was able to crawl to the phone
and call 911. Paramedics in an ambulance took her to a nearby tertiary hospital. X rays of the cervical spine
showed a high-cervical fracture.

Miss S. was a delightful woman, slight in stature with frail skin and severe osteoporosis. She was placed in a halo
body jacket and underwent uneventful cervical spine stabilization. Because of her advanced age and potential
respiratory issues, she was placed in the neurosurgical intensive care unit postoperatively.

After the first 48 hours, Miss S developed difficulty eating; a swallowing evaluation demonstrated partial paralysis
of the pharynx and vocal cords. A small-bore feeding tube was placed to prevent aspiration pneumonia. Within a
few days, she was transferred to the surgical ward and she began working with occupational and physical
therapists. The neurosurgeon began talking to Miss S. about discharge planning. She vehemently opposed to
placement in an inpatient rehabilitation facility and insist to go home.

After a few days, she acquired pneumonia so she was transferred back to the intensive care unit in acute
respiratory distress. She improved enough to be transferred back to the surgical ward. Miss S. had little control
over her surroundings and grew more depressed as other complications, such as skin breakdown around the pin
sites on her forehead, developed. Miss S. had difficulty to move even with the assistance of physical therapy.
Because of her slight frame, she often toppled over after sitting up. She had little return of oral function and could
not eat.

Early one morning, with the team on rounds, Miss S took control. She told the resident and the nurse that she
thought all night about physician-assisted suicide. She said she would refuse to spend another penny on her own
health care, especially when the money could be left to her family instead. She had been miserable for several
weeks, and she saw no end in sight. In addition to asking for her feeding tube to be removed, she wanted help in
ending her life. She was awake, alert, oriented, and specific in her wishes. The plan that Miss S. presented to her
healthcare team left them stunned and unprepared; however, she emphasized that only she can make decisions
for herself.

How will the health care professionals ethically respond?