A woman was diagnosed with a motor neuron disease 5 years ago. This condition destroys motor nerves, making control of movement impossible, while the mind is virtually unaffected. People with this disease normally die within 4 years of diagnosis from suffocation due to muscle weakness. The woman's condition has steadily declined and she is not expected to live through the month. She is worried about the pain that she will face in her final hours. She asks you, the palliative care PA, to give her a strong pain medicine if she begins to suffocate or choke. This will lessen her pain, but hasten her death. A few days later, she falls very ill and is having trouble breathing. What should you do?

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