1. An 80 years old man with terminal metastatic colon cancer is in excruciating pain. Giving him a high dose of morphine which could inadvertently cause respiratory depression is indicated.
2. An 88 years old man with cancer of the prostate presents with painful metastasis to the L5 vertebra. He is not able to walk and is bed ridden. He refuses radiation therapy to the vertebra and requests for surgical decompression as he has hopes that this would cure him. He is scheduled for a decompression surgery.
3. A 90 years old woman presents to the emergency room unconscious. She has a living will which clearly dictates Do Not Resuscitate orders. She is admitted and observed. Her breathing is labored. She is given morphine to ease her respiratory efforts.
4. A 96 years old woman is brought to the ER in cardiac arrest. There is no living will and there is nobody with a power of attorney. The physician in charge of the ER decides to withhold resuscitation considering her advanced age.

Answer: The answer is (d). Truth telling, beneficence, nonmaleficence, autonomy and distributive justice are the guiding principles of ethically sound medical practice. The principle of double effects argues that the potential to hasten imminent death is acceptable if it comes as an unintended consequence of a procedure or treatment which is aimed at easing pain or causing comfort. Therefore in the first scenario giving the morphine to relieve pain is ethically acceptable. In cases of conflict, where the physician feels that a treatment option is futile and nonproductive but the patient demands the option it is only ethical to explain in detail the consequences and then go ahead with the requested procedure or treatment if the patient still wants it. Giving morphine to ease respiratory discomfort is not a resuscitative measure. Therefore carrying it out in a do not resuscitate patients is ethically sound.