A 72-ycar-old man comes to see you because of severe pain from metastatic prostate cancer to the bones. His pain has become progressively more severe and has not responded to localized radiation, flutamide, or goserilin. In addition, numerous pain medications have failed to achieve an acceptable level of analgesia. He nocds morc intense pain management with subcutancous or intravenous opiates. He also has severe COPD and there has been concern about the effect of the opiate medications on the patient's respiratory drive. In other words, the only way to achieve a sufficient amount of pain relief is to use medications that may shorten his life, inadvertently, because of respiratory depression. The patient is fully alert and has the capacity to understand the problem.
Which of the following is the most ethical way to approach his pain management?
a. It is all right as long as he is DNR.
b. It is acceptable as long as the patient understands the risks.
c. It is unacceptable to shorten life with physician-administered medications.
d. Intubate the patient then give the pain medications.
e. Leave him in pain as long as the respiratory drive is not impaired.
f. Offer to end his life with pain medications.