Physician-Assisted Dying Witnessed by Emergency Medical Services: A Case Report
Abstract
Introduction: Physician-assisted dying (PAD) is a practice that allows terminally ill patients to self-administer prescribed lethal medication. In the 11 U.S. states where PAD is legal, the incidence of PAD cases is rapidly increasing. Despite the majority of these cases occurring in the out-of-hospital setting, states lack specific emergency medical services (EMS) protocols to guide prehospital clinicians who may encounter PAD in the field. Here, we describe a case in which a patient called 9-1-1 for a medical emergency and requested to ingest their prescribed lethal medication while in EMS care.
Case Report: EMS was dispatched for a 56-year-old female who was bleeding from her tracheostomy stoma. Despite the clinicians’ recommendation for transport to the emergency department, the patient refused transport and instead requested to ingest her PAD medication. The crew, unfamiliar with PAD laws, were unsure if they could legally honor the patient’s refusal. Clinicians consulted with on-line medical control, who were also unaware of PAD. After extensive deliberation, the crew eventually decided to honor the patient's refusal and thoroughly document the situation. The patient self-administered her medication as EMS cleared the scene.
Conclusion: This case highlights the logistical challenges and ethical dilemmas faced by the responders, and underscores the complexity of balancing patient autonomy with legal and medical responsibilities in prehospital PAD situations. As PAD becomes increasingly prevalent, equipping EMS clinicians with clear protocols and ongoing education about prehospital PAD cases is vital to preserving patient rights while protecting clinicians from legal and ethical uncertainty.