Mrs. Randall

Pauline Randall, a 65-year-old married woman with three adult children, has been suffering from amyotrophic lateral sclerosis (ALS) for several years.  Her neurological condition has deteriorated so that she can no longer control any voluntary muscles.  Confined to a bed in a nursing home in a small Midwestern American city and breathing with the aid of a respirator, she communicates through the electronic monitor that responds to eyelid blinks.  She can ‘write’ words and brief sentences in this way.

            Mrs. Randall understands that her condition cannot be treated and that it will inevitably lead to her death.  But she has been an active participant in her health care and has been determined to continue functioning as long as possible.

            Her physician, Dr. Samuels, believes that she is not receiving adequate nutrition and that the time has come to insert a nasogastric feeding tube.  When he proposes this procedure to her, she blinks quickly, ‘No more!’ He asks, ‘Do you understand you will die slowly of starvation if we do not insert this feeding tube?” “Yes,” she blinks, “No more.”

            When Mrs. Randall’s family, which has been close and supportive through her illness, learns of her opposition, they have divided opinions.  Her husband believes that her wishes should be respected, but two of their three children are convinced that her life should be prolonged.  The nursing staff believes that she should not be made to suffer any longer.

            There is no question that Mrs. Randall is legally competent, that is, that she understands the procedure being proposed and the consequences of refusal.  Should her refusal of the feeding tube be honored, even though it will lead to her death?

* http://ethics.iit.edu/EEL/Right%20to%20Die.pdf