I think it's both. Dean's not about to leave Sam to die by himself and spend his last normal hours alone in an abandoned clinic; he's not about to let anyone else touch Sam; he knows he can't let Sam go apeshit and kill other people; and I think there's a hell of a good chance he'd be dead in the end too, either because he hesitates in shooting Sam and Sammy infects him, or he just fuckin' shoots himself anyway. Dean can't survive without Sam anyways. So why bother.
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