A woman was diagnosed with motor neuron disease (the same disease that Stephen Hawking had) 5 years ago. This condition destroys motor nerves, making control of movement impossible, while the mind is virtually unaffected. People with motor neuron disease normally die within 4 years of diagnosis from suffocation due to the inability of the inspiratory muscles to contract. The woman's condition has steadily declined. She is not expected to live through the month and is worried about the pain she will face in her final hours. She asks her doctor to give her diamorphine for pain if she begins to suffocate or choke. This will lessen her pain but also hasten her death. About a week later, she falls very ill and is having trouble breathing.

**Questions for Case One:**

1. Does she have a right to make this choice, especially in view of the fact that she will be dead in a short while (say six hours)? Is this choice an extension of her autonomy? Why or why not?

2. Is the short amount of time she has to live ethically relevant? Is there an ethical difference between her dying in 6 hours and dying in a week? What about a year, and how do you draw this distinction?

3. Is the right for a patient's self-determination powerful enough to create obligations on the part of others to aid her so that she can exercise her rights? She clearly cannot kill herself. She can't move, but should someone be forced to help her or to find someone to help her?

4. Should the money used to care for this woman be taken into account when she is being helped? Do you think that legalizing Doctor Assisted Death could create conflicts of interest for the patient or the doctor? Will people feel that they need to end their lives earlier to save money and not be a burden on their families?

5. If you were the physician, what would you do? Note: If you would pass her off to another doctor knowing he or she would do it, does this free you from your ethical obligations?