Euthanasia and Assisted Suicide - Physician-assisted Suicide

Dr. Quill: A Model Case …

A well-publicized case of physician-assisted suicide in 1991 continues to be a major topic of discussion among those in the medical, bioethical, and legal professions. Dr. Timothy Quill, in "Death and Dignity—A Case of Individualized Decision-Making" (New England Journal of Medicine, vol. 324, no. 10, March 7, 1991), wrote about helping a patient identified as Diane commit suicide. Dr. Quill, who had known Diane for eight years, had seen her battle and overcome alcoholism and depression. Eventually Diane was diagnosed with an acute form of leukemia. She was very sure not only that she would die during treatment, but also that she would suffer unbearably while undergoing chemotherapy (drug treatment to fight cancer). Diane decided that she would rather end her life than lose control over her body. Dr. Quill prescribed barbiturates that Diane subsequently used to kill herself.

Through an anonymous tip, authorities identified the real "Diane" whom Dr. Quill had helped to commit suicide.

TABLE 6.5
Patients' attitudes toward and experiences with euthanasia and physician-assisted suicide (PAS), 2002¹

As a result, the case was brought to a grand jury. Asked to decide whether Dr. Quill's action constituted a crime, the grand jury declined to recommend an indictment. Meanwhile, the New York State Department of Health's Board for Professional Misconduct considered his actions "legal and ethically appropriate."

Many observers were not surprised at the outcome of the grand jury proceedings. They cited growing public concern about how easily patients could lose control over end-of-life decisions. Some bioethicists thought that Dr. Quill's handling of Diane's case would make a suitable model for how physician-assisted suicides should be practiced. Many of Dr. Quill's colleagues lauded his act, some claiming that it was generally known that some doctors do assist in suicides. They were glad that, because of Dr. Quill's confession, the practice was now in the open.

… Or a Case of Misguided Judgment?

Dr. Herbert Hendin, a psychiatrist and psychologist as well as a world-renowned authority on suicide, claimed that "the doctor assisting a suicide is not simply a dispassionate observer responding to the patient's needs and wishes." In Seduced by Death: Doctors, Patients, and the Dutch Cure (New York: W. W. Norton and Company, 1997), Dr. Hendin noted that Dr. Quill's account of Diane's suicide belied his supposedly disinterested, albeit compassionate, response to his patient's request. Dr. Hendin believed "emotional involvement" on Dr. Quill's part "[had] clouded his judgment."

When Diane decided to refuse the treatment recommended by her oncologist (cancer specialist), Dr. Quill, instead of exploring with the patient the reason for her seemingly hasty decision, told his readers, "Together we lamented her tragedy and the unfairness of life." Dr. Hendin believed Diane must have been suffering from depression. Once she had told Dr. Quill of her decision to end her life, she calmed down. Dr. Hendin explained that suicidal people become less depressed after their decision: "Coping with the uncertainties of life and death is what agitates and depresses them."

Dr. Hendin believed that Dr. Quill's failure to challenge Diane's presumption that the cancer treatment would fail opened the door to her next decision—to commit suicide with Dr. Quill's help. Although Dr. Quill told Diane that he could not assist in her suicide, Dr. Hendin claimed in his article that Dr. Quill "appears to have conveyed

TABLE 6.6
Provisions of Oregon's Death with Dignity Act

to her … that her request 'made perfect sense'," and he subsequently referred her to the Hemlock Society. Founded in 1980, the Hemlock Society advocates for choice and dignity at the end of life and the legal availability of the means to hasten death. Dr. Hendin felt it probably confused the patient to hear Dr. Quill saying that he was "leav[ing] the door open for her to change her mind," while he simultaneously directed her to a place that could help her fulfill her wish of death. "Quill once again powerfully shaped the clinical interaction between himself and his patient," wrote Dr. Hendin.

Dr. Hendin pointed out that, at her last meeting with Dr. Quill, Diane promised she would reunite with the doctor "in the future at her favorite spot on the edge of Lake Geneva, with dragons swimming in the sunset." According to Dr. Hendin, "death as a metaphor for reunion in a magical netherworld is a common fantasy among suicidal people. That both doctor and patient shared it suggests that neither really came to grips with the fact of death."

Dr. Quill, an active advocate of the legalization of physician-assisted suicide, joined two other physicians and three patients in 1994 to sue the New York State Attorney General for violating the Fourteenth Amendment by banning physician-assisted suicide. The Supreme Court ruled on this case in June 1997, reversing an earlier ruling made by the Court of Appeals for the Second Circuit. The Supreme Court distinguished between withdrawing life-sustaining treatment and physician-assisted suicide, and differentiated between physician actions taken to relieve pain and suffering and those intended to hasten death.