Box 2.

Case study: committing to non-abandonment

Dr. Rhodes*, a hospice and palliative care physician, was approached by Jacob, a patient in his late 60s diagnosed with late-stage cancer. Jacob was a veteran who had lived a solitary life after a brief marriage. He had no relationships with family and did not want to pursue any medical treatment because he did not want to become dependent on caregivers. Jacob had investigated various methods of suicide but determined that Act 39 would cause the least distress for others. Dr. Rhodes felt surprised by her ambivalence. She viewed prescribing as bearing a tremendous moral and emotional responsibility and she did not take the decision lightly. Yet she understood Jacob’s choice and saw it as rational because it reflected the way he had lived his entire life. Moreover, she was committed to non-abandonment, and she was convinced that if she did not write the prescription, Jacob would end his life in a more gruesome manner. Dr. Rhodes consulted with experienced colleagues and a pharmacist about the protocol. She also contacted Jacob’s hospice nurse to make sure that she felt comfortable caring for him. Jacob chose to be alone for his death, which required some coordination with his hospice nurse so that she could care for him afterward. Prior to Jacob’s death, Dr. Rhodes visited him in his home to say goodbye. *All names are pseudonyms.