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Welcome to our case series about Physician Assisted Dying. 

This is a complex issue. This case series is designed to stimulate discussion and illustrate some of the challenges we may face. 

For the purposes of this case, we will assume that legislation is now in place that allows PAD. 

You are a family physician caring for Leo, a 68 yo man with end stage Non-Small Cell Ca, metastatic to brain and liver.  He has had excellent palliative care, aided by your team and the guidance of a regional palliative care consultant, who visits your community from a tertiary centre.   

He was admitted to your community hospital last week, and has progressed rapidly toward dying.  Unfortunately, he has developed delirium, presumably from multi-dimensional causes (metabolic effects, brain metastases and drug related).  It is recalcitrant to sustained effective treatment, and the result is a patient who is very agitated and aggressive, who appears in distress, and a family who is suffering terribly.