Problem
Ms. SK was a 77-year-old woman followed by oncology for her widely metastatic lung cancer. Her disease was refractory to treatment and progressed; she grew weaker. She chose comfort-focused care and refused further cyto- toxic therapy. Extensive osseous involvement began to cause her excruciating bone pain at multiple sites, and the pain progressed despite several courses of palliative radiation therapy, bisphosphonates, and increasing doses of opioids and co-analgesic medications. She was dyspneic and anxious, with both symptoms aggravated by her severe pain. She was admitted to a local hospital for general decline, dehydration, and severe pain. Increasing doses of intermittent intravenous morphine were administered with suboptimal effect, and 2 days after admission, a continuous morphine infusion with prn clinician-administered boluses was ordered. After aggressive dose titration, at last, the patient seemed to achieve an acceptable level of comfort and calm. She remained intermittently awake and interacted with family at her bedside, but some of the staff was un- comfortable administering increasingly high doses of opioid, fearing that they would hasten the patient's death.
Explain your stand using each of the 4 basic conditions.
A. The act-in-itself cannot be morally wrong or intrinsically evil. (Explain your stand based on the scenario)
B. The bad effect cannot cause the good effect. (Explain your stand based on the scenario)
C. The agent cannot intend the bad effect. (Explain your stand based on the scenario)
D. The bad effect cannot outweigh the good effect; there is a proportionate reason to tolerate the bad effect. (Explain your stand based on the scenario)