Opinion | Ethics Consult: Should Doc Illegally Assist Suicide in Dire Circumstance?

Welcome to Ethics Consult — an opportunity to discuss, debate (respectfully), and learn together. We select an ethical dilemma from a true patient care case. You vote on your decision in the case and, next week, we’ll reveal how you all made the call. Bioethicist Jacob M. Appel, MD, JD, will also weigh in with an ethical framework to help you learn and prepare.

The following case is adapted from Appel’s 2019 book, Who Says You’re Dead? Medical & Ethical Dilemmas for the Curious & Concerned.

A major hurricane strikes a midsize U.S. city located on the Southeast coast. The city’s largest hospital, which is situated on a peninsula, loses electricity and cell phone service. It is entirely shut off from the outside world. Fierce winds batter the building, and after the storm abates, temperatures on the wards rise to over 90°F. Much of the staff abandons the hospital on makeshift rafts, leaving only Abigail Bartlet, MD, and a handful of nurses to care for more than 20 extremely ill intensive care unit (ICU) patients. Bartlet realizes that the backup generators will run out of energy after 48 hours, shutting off the machines that are keeping many of her patients alive.

One of the patients, Sylvia, is a quadriplegic woman who needs a ventilator to survive. She summons Bartlet and says to her, “You and I both know these machines are going to shut off eventually and I’m going to die a painful death. I’m 72 years old. I’ve lived a good life. What I want right now is a lethal dose of morphine so I can pass with comfort and dignity.”

Physician-assisted suicide is illegal in this state. Although Bartlet knows this, she fulfills Sylvia’s request, and Sylvia dies. Hours later, before the generators fail, the National Guard arrives to evacuate the remaining patients.

Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at the Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.

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