Tina, age 56, was diagnosed with cervical

Tina, age 56, was diagnosed with cervical cancer two years ago. She underwent surgery and chemotherapy for 11 months. The chemotherapy was very difficult on Tina. She was constantly sick, lost her hair, and was depressed. However, at the end of the chemotherapy, she was given a positive report and declared cancer free. She had a follow-up every 6 months for a CT scan. At her first 6 month visit, Tina received a positive report. When she had her second follow-up visit, the CT scan revealed that the cancer had returned–and aggresively. Tina’s oncologist recommended a second surgery to remove cancerous tumors followed by another round of intensive chemotherapy. Tina was immediately depressed. She felt that her life was just begining to be normal again. Tina was concerned that she could not witstand chemotherapy a second time. She made a few sporadic comments about death as an alternative. But with the support and encouragement of her family, friends, and doctors, Tina agreed to the oncologist’s treatment plan of a second surgery and aggressive chemotherapy. The second surgery was successful in that the surgeon removed many cancerous tumors, but the pathology report revealed that the cancer had spread to Tina’s lungs. Tina’s oncologist recommended continued chemotherapy, but with an increased dosage to also fight the nodules in her lungs. Despite approximately 6 months of chemotherapy, Tina’s cancer continued to grow and had even spread to her bones and liver. Tina’s oncologist sadly classifies Tina’s cancer as “terminal” and estimates that she will most likely die in the next 3-4 months. He recommends discontinuing chemotheraphy and instead provide pallative care for her remaining months. As such, the doctor prescribes pain medication to relieve her pain. Despite telling the doctor that she will, Tina does not take the pain medicine. Tina is in extreme pain and her depressed attitude has continued, if not even worsened. She is often somber and does not want to get out of bed. She has been making comments again about favoring a quick death rather than a prolonged death by cancer. About a month after her terminal diagnosis, Tina’s husband, John, must attend a one night business trip. Their grown daughter, Emily, is going to stay with Tina while John is away, but she cannot come to Tina’s home until after she finishes work at 4:00 p.m. Emily checks on Tina throughout the day. She calls after work and asks Tina what she wants for dinner. Emily picks up dinner and arrives at Tina’s home around 4:40 p.m. Emily calls up to Tina’s bedroom, but receives no response. Concerned, Emily goes to Tina’s bedroom. She discovers Tina lying on the floor, alive, but barely breathing. Tina had attempted suicide by gunshot. Emily immediately calls 911. Tina is taken to the nearest emergency department. She is placed on a ventilator and slips into a coma. She is taken to surgery and teh gunshot wound is repaired. The surgeon states that with the location of the gunshot wound there is a 50/50 chance that Tina will recover. The surgeon, however, is optimistic and believes that Tina’s chances are likely a little better, although he cannot give an exact percentage. The surgeon is not sure how much brain function Tina will have, although she will have some. Tina remains on a ventilator. Tina did not have an advanced health directive. Like many, it was one of the things that Tina had meant to do, but had not gotten around to doing. Emily discovers a handwritten note from Tina. In the note, Tina stated that life with incurable cancer wasn’t worth living. She asks the doctors to “finish” her suicide by withholding life support, such as a ventilator, in the event that her survived her suicide attempt. Tina’s family wants Tina taken off the ventilator. The physician, however, is reluctant to remove the ventilator because he is concerned that he would be assisting in a suicide, which is prohibited by state law. What do you believe should be done? SCIENCE HEALTH SCIENCE NURSING NURSING 211

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