Ethics - hsar

[ArchivalUser]

A q from NBME that I partially remember:

End-stage cancer patient has his severe pain moderately controlled by IV morphine given at regular intervals by hospital staff. Morphine causes him respiratory difficulties, and patient is requesting you to help him end his life. What do you do?
1. increase morphine dose
2. decrease morphine dose
3. give lethal dose of morphine
I don't remember the other 2 choices. Anyone who remembers this q....?

Can anyone tell me what the right thing to do is? In general, too, what do you do when pt requests euthanasia?

[ArchivalUser]

hsar, here you go

A 48 year-old man with advanced metastatic gastric cancer is admitted to the hospital because of severe abdominal pain High doses of oral analgesics, including numerous opioids, nonsteroidal anti-inflammatory drugs, and tricyclic agents, have not been successful in managing the pain Morphine administered by intravenous infusion successfully controls his pain, but the doses needed cause respiratory depression. He has repeatedly stated that he does not want cardiopulmonary resuscitation and that he wishes "to die with dignity without unnecessary pain." Which of the following is the most appropriate course of action?
A) Administer the lowest dose of morphine that relieves pain, even if it depresses respiration
B) Decrease the dose of morphine and administer an anxiolytic
C) Decrease the dose of morphine, explaining that he will have to tolerate some pain
D) Discontinue morphine and try different analgesics
E) Increase the dose of morphine progressively until the patient stops breathing

[ArchivalUser]

A - treat the patient so he could avoid pain regardless of some known complication of analgesics

[ArchivalUser]

Thanks, irina25 & whiteblue.