11-20-2006, 05:34 PM
An 81-year-old woman is in the hospital for terminal breast cancer. She was admitted to the service 3 days ago after being brought to the hospital by her family for worsening mental status. The patient was diagnosed with breast cancer 2 years ago, and the disease is now widely metastatic to her spine and brain. Her family is concerned that she is not being given adequate sedation and analgesia. She has long-standing bone pain and had been using a fentanyl patch and hydromorphone orally at home. She is currently on a morphine drip. The family would like the rate of the drip increased. Evaluation of the patient reveals a cachectic woman lying comfortably in bed. Her blood pressure is 100/60 mm Hg, pulse is 76/min, and respirations are 14/min. She appears to be sleeping. The family demands that she be "made to stop suffering" and asks that her quantity of morphine be increased. Which of the following is the most appropriate course of action?
A. Decrease the morphine drip rate as the patient appears sedated
B. Ignore the family's wishes as the patient appears comfortable
C. Increase the morphine drip rate
D. Inform the family that the patient appears comfortable and to not make requests of the medical team
E. Inform the family that a physician cannot participate in killing a patient
A. Decrease the morphine drip rate as the patient appears sedated
B. Ignore the family's wishes as the patient appears comfortable
C. Increase the morphine drip rate
D. Inform the family that the patient appears comfortable and to not make requests of the medical team
E. Inform the family that a physician cannot participate in killing a patient