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End of Life Decisions

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Case Study: End of Life Decisions

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George is a successful attorney in his mid-fifties. He is also a legal scholar, holding a teaching

post at the local university law school in Oregon. George is also actively involved in his teenage

son’s basketball league, coaching regularly for their team. Recently, George has experienced

muscle weakness and unresponsive muscle coordination. He was forced to seek medical

attention after he fell and injured his hip. After an examination at the local hospital following his

fall, the attending physician suspected that George may be showing early symptoms for ALS

(amyotrophic lateral sclerosis), a degenerative disease affecting the nerve cells in the brain and

spinal cord. The week following the initial examination, further testing revealed a positive

diagnosis of ALS.

ALS is progressive and gradually causes motor neuron deterioration and muscle atrophy to the

point of complete muscle control loss. There is currently no cure for ALS, and the median life

expectancy is between three and five years, though it is not uncommon for some to live 10 or

more years. The progressive muscle atrophy and deterioration of motor neurons leads to the loss

of the ability to speak, move, eat, and breathe. However, sight, touch, hearing, taste, and smell

are not affected. Patients will be wheelchair bound and eventually need permanent ventilator

support to assist with breathing.

George and his family are devastated by the diagnosis. George knows that treatment options only

attempt to slow down the degeneration, but the symptoms will eventually come. He will

eventually be wheelchair bound, and be unable to move, eat, speak, or even breathe on his own.

In contemplating his future life with ALS, George begins to dread the prospect of losing his

mobility and even speech. He imagines his life in complete dependence upon others for basic

everyday functions, and perceives the possibility of eventually degenerating to the point at which

he is a prisoner in his own body. Would he be willing to undergo such torture, such loss of his

own dignity and power? George thus begins inquiring about the possibility of voluntary


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