Mrs. Rogers is 71 years old with a carcinoma at the base of her
tongue which has metastasized to her neck. She was treated with a radical
neck dissection in January of 1990. A year later she developed acute renal
failure which made her dependent on dialysis. At this time she was found
to have squamous cell cancer with lung metastases. She was a heavy smoker
and abused alcohol. The cancers could not be treated because of their advanced
state and her poor nutritional condition. In discussing her dialysis, her
nephrologist, Dr. Edwards suggested that she might want to discontinue
it because a death from renal failure is much less painful that the fate
which the cancers would present. The managed care group to which she belongs
and "strongly urged" Dr. Edwards to take this approach with her. She has
a prognosis of 4-6 months to live and pain control was becoming a major
problem. Mrs. Rogers said that she wanted to continue the dialysis for
another month so that she could "get her affairs in order." In the next
month she made no attempt to accomplish this goal but continued to smoke
and drink excessively. When Dr. Edwards reported the lack of progress to
the managed care group, the group immediately said that they would no longer
cover the cost of her dialysis.