Euthanasia in Old Age:

A Case Study and Ethical Analysis

DIANE E. MEIER. MD.·and CHRISTINE K. CASSEL, MDt

REPORT OF A CASE and cknowl edged that she knew he would not b going
home. Sh
A 72-yc tr-old woman was admitted to the t hen a ked that her friend be a ked to come in, and he
University Hospital for evaluation of hon p.in. Eiht dictated will.
month earlier a dia no i of lung cancer had been
made , nd he had received a cour e of radiation
thempy. This a-e ulted in some reduction in tumor ize
but led to cvcre radiation pncumonit is, requiring three
ho pitaI admi Ion . During t h • two weeh prior to
thh dmission • .he had pain in both hip , m king w
lklng extremely difficult , and he experienced
worscnln hort n • of breath and cough.
Radiograph s revealed metastatic tumor ln the hip , an
enlargin ma I n t he l u ng, ttnd pneumoni. . he wa
Riven rndia.tion therapy to the rejfion of meta tatic dt
c .c, wa treated for t h pncu rnonl . nd improved.A A
·r he hac.J been in the ho$pitnl about two weeh. bone p
in
r curred and everal new areas of mewtutic cancer
were found in her hand nd rib . Radi lion was begu n
to the e areM '" well. Her- breathing became quite
difficult.and becau e of evere chronic ob tructive
pulmonary di ea e he rett uir d large do e of
bronchodilator ., nd continu ous oxygen therapy. At
the time the cOur$e of radiation therapy wn
completed, pncu1nonia developed gain, re quiring
intcm.ivc rcpimtory cnre and two more weeks of
intr:wcnou antibiotic therap)'.The bone lesion did not
respond to the radiation .
The patient h d been widowed yea.rs earlier and
lived aJonc in an apartment. he had no living
family.She wa rettred high chool teacher. n1u icl n,
and an avid render. he had one clo e friend, a
neighbor, who \ i lted her I n the ho ·pitnl frequently.
Throul(hout this ho pi tali:rntion he had cxprcs.11ed t he
deirc to get bade home to her pi. no and her book .
Her phy icianbegan to realize that because of the rapid
progre ion of her tumor, h r p;itin, and her
tenuou bre thing tntu , he would probabJy
not be ab!• to l av the ho pital before h r
death. She wa told of th falJure of the radiation th
ropy to halt the spread of her tumor and wa d vi ed that
h prob bly could not rt.-ccivt dcqu tc care • t home .
She wa rea sured that her breathing would b upport d
o t h l he would not feel hort of breath, and thllt her
pain would be tre t d. At th,.1t point he w pt
 The remainder of her time in the hospital wn Tenn.
compli C t d by M!vcrc bone p.in and constant
dyspnca. arcotic analgesic giwH1 in do c odequ11te
to relieve pain sui> pressed her breathing, thr t ning
re piratory arre t and death. he wa told of the risk
and still reque ted enough
medication to r·licve pain. Morphine in small do e ,
every three hour: • re ulted rn partial relief of pain
and a wndng und waning mentnl stntus. Her brthing
lowed
and becam more h llow ofter each do e of narcotic.She
wns intermittently lucid and stated, when ll ked , th t
he was till In pain and needed more mt>dlcation . Th
do e of morphine wa lncre ed. Bild she became unre
pon- ive, with low and labored br thing. ome
members of the health care team felt that t he
morphine should be topped, a they were afo1id it
would uppre her breathing !together. On cveral
occasions it wu.s not given.and h r breathing. mental
talus, nd p in returned to baseline . A d clsion wa
made hy tbe pat ient, her physicians. and the hruid
nurse to continue the morphine In the do •' r quired to
relieve her pain. The nurse who were u ncomfortable
with lhh. cour of ctlon were tran ferred to care for
other patient . The pati n t died three days later of o
respiratory a.rre t.

DI CUS ION

The priocip l i ues rai ed by thi story are

care for the dying elderly and the problem of
euthana ia. Phy ician and nur e are often faced
with the i ue of how aggressive they should b
in the provision of modem diagno tic und
thcrnpeu tic mea urc to th elderly. Medical
technology now permit u
to
prolong biologic life for a considerable time after
n
meaningful human existence has ceased, and
deci· ion not to employ lifi
upport, or to withdrnw it:. arc freq u ntly
made in our ho pital . Thi ca e. however,
focu e on the conflict that arise. wh n an
effective treatment i likely to hortcn life.
Any medical i nterven tion that may cause or
hast n
death, in the narne of relieving sufferin , raises
the ue of euthana ia.

Definition of