Request for euthanasia in terminal illness
A 72-year-old man with metastatic non-small cell lung cancer is admitted with progressive dyspnoea and pain. His performance status is 3 (bedridden more than 50% of the day). He is alert and oriented, and has a validated depression screen score just below the threshold for major depression. He asks you to ‘end his suffering’ and requests a lethal injection. He says he has discussed this with his wife, who supports his wish. He is not in an acute crisis, but his breathlessness is distressing. He has a do-not-resuscitate order. He has capacity and refuses further chemotherapy. You are the covering medical officer in a Malaysian public hospital. The family is present and asks you to respect his request.
1. How do you respond to the request for euthanasia?
Read the worked answer
Euthanasia and assisted suicide are illegal in Malaysia, so you cannot comply. Respond with empathy, not judgment. Acknowledge his suffering and explore what is driving the request: pain, breathlessness, fear, depression, or feeling like a burden. Reassess for depression even though the screen is below threshold; treatable depression can amplify requests. Explain that you cannot end his life, but you can work aggressively to relieve his symptoms. Involve the palliative care team. The reasoning is that respecting autonomy does not require acceding to an illegal request; instead, it requires addressing the suffering that underpins it.
2. What palliative care options should be explored?
Read the worked answer
Optimise symptom control: titrate opioids for pain and breathlessness, use oxygen if hypoxic, and consider a fan for dyspnoea. Treat anxiety with benzodiazepines if needed. Address constipation, nausea, and dry mouth. Discuss advanced care planning, including his do-not-resuscitate order and goals of care. Explore psychosocial and spiritual needs, and involve his wife and family in supportive discussions. Offer a palliative care consult. The reasoning is that good palliative care can relieve suffering and may reduce the desire for hastened death.
3. What legal and ethical considerations guide your documentation?
Read the worked answer
Document the request for euthanasia, your response, and the alternatives offered. Record the capacity assessment, the depression screen, and the discussions with the patient and family. Note that you explained the legal prohibition and that you offered palliative care. Document his ongoing symptoms and the plan. The ethical principles are autonomy (respected within legal limits), beneficence (relieve suffering), non-maleficence (do not kill), and justice (uphold the law). Good documentation protects the patient and the clinician, and ensures continuity of care.