Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: THURSDAY, March 7, 1991 TAG: 9103070517
SECTION: NATIONAL/INTERNATIONAL PAGE: A/1 EDITION: EVENING
SOURCE: Associated Press
DATELINE: BOSTON LENGTH: Medium
The case is the latest in a series of incidents in which doctors have participated to varying degrees in the deaths of patients, but rarely have doctors openly described such participation.
In the essay in today's New England Journal of Medicine, Dr. Timothy Quill of the University of Rochester described how he prescribed sleeping pills, and told the patient how many she needed to kill herself, when she could no longer stand the pain of her acute myelomonocytic leukemia and wanted to die.
Several experts said Quill acted both legally and ethically.
"From my point of view, this story comes as close as I can imagine to a morally defensible role for a physician in the suicide of a patient," said Arthur Caplan, a bioethicist at the University of Minnesota.
However, Dr. Nancy Dickey, a trustee of the American Medical Association, said that while Quill did not illegally assist in the suicide, she was troubled by even this much involvement.
"We don't get to choose the moment of our arrival into this world, and I don't believe we have the right to choose the moment of our departure," she said. "The AMA suggests that physicians will not assist in achieving that goal."
Quill said he told the story of his patient, whom he identified only as Diane, to bring the discussion of death and suffering into the open.
"We can't do that without talking about real examples," he said in an interview. "I hope this will cause doctors who take care of severely ill patients to think seriously about what they do and how they handle these situations."
In his essay, Quill said he told Diane, his patient of eight years, that she had a 1-in-4 chance of surviving chemotherapy and bone marrow transplantation and gaining a long-term cure.
But she refused such a course of treatment because "she was convinced she would die during the period of treatment and would suffer unspeakably in the process."
Diane wanted to be in control of her life and her dignity, Quill wrote. "When this was no longer possible, she clearly wanted to die," he said.
At Diane's request, and after he was sure she understood her decision, Quill prescribed barbiturates and told her how to use them.
"I wrote the prescription with an uneasy feeling about the boundaries I was exploring - spiritual, legal, professional and personal," Quill wrote.
"Yet I also felt strongly that I was setting her free to get the most out of the time she had left and to maintain dignity and control on her own terms until her death."
After several months of spending as much time as possible with her husband and son, pain began to dominate Diane's life. About a year ago, at age 45, she took the pills and died at home.
Three years ago in the Journal of the American Medical Association, a doctor wrote an anonymous and controversial article describing how he gave a lethal injection of morphine to a suffering cancer patient he did not know.
Last year, a Michigan doctor hooked an Alzheimer's victim to a machine he invented that let her give herself a fatal injection with the press of a button. He was charged with murder, but a judge dismissed the case.
by CNB