The New England Journal of MedicinePerspective: Something for Sleep

Patient Autonomy and Trust: A Physician’s Ethical Journey in Palliative Care

This article presents a compelling narrative of a physician’s ethical journey with a patient battling terminal cancer. It explores the complexities of patient autonomy, trust, and the ethical boundaries of medical practice, offering valuable insights for healthcare professionals.

Key Points:

• The patient, a woman with a history of overcoming personal adversities, was diagnosed with leiomyosarcoma.
• She requested a prescription for Seconal, a barbiturate, not for its intended use but as a means to end her life if her condition became unbearable.
• The physician wrestled with the ethical implications of the request, balancing the patient’s autonomy with the responsibility to do no harm.
• The patient and physician eventually reached an agreement: the physician would provide the prescription, and the patient would communicate honestly about her symptoms and intentions.
• The patient never used the medication but found comfort in having control over her situation.
• The patient’s journey ended in home hospice, with her son by her side. She returned the unused prescription to the physician, demonstrating that control, not the act of ending her life, was her primary concern.

According to the World Health Organization, an estimated 40 million people are in need of palliative care each year, but only 14% actually receive it.

More on Palliative Care