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A Case of Physician Assisted Suicide

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					A Case of Physician Assisted Suicide


Diane was a patient of Dr. Timothy Quill, who was diagnosed with acute
myelomonocytic leukemia. Diane overcame alcoholism and had vaginal cancer
in her youth. She had been under his care for a period of 8 years, during
which an intimate doctor-patient bond had been established. It was Dr.
Quill’s observation that “she was an incredibly clear, at times brutally
honest, thinker and communicator.” This observation became especially
cogent after Diane heard of her diagnosis. Dr. Quill informed her of the
diagnosis, and of the possible treatments. This series of treatments
entailed multiple chemotherapy sessions, followed by a bone marrow
transplant, accompanied by an array of ancillary treatments. At the end
of this series of treatments, the survival rate was 25%, and it was
further complicated in Diane’s case by the absence of a closely matched
bone-marrow donor. Diane chose not to receive treatment, desiring to
spend whatever time she had left outside of the hospital. Dr. Quill met
with her several times to ensure that she didn’t change her mind, and he
had Diane meet with a psychologist with whom she had met before. Then
Diane complicated the case by informing Dr. Quill that she be able to
control the time of her death, avoiding the loss of dignity and
discomfort which would precede her death. Dr. Quinn informed her of the
Hemlock Society, and shortly afterwards, Diane called Dr. Quinn with a
request for barbiturates, complaining of insomnia. Dr. Quinn gave her the
prescription and informed her how to use them to sleep, and the amount
necessary to commit suicide. Diane called all of her friends to say
goodbye, including Dr. Quinn, and took her life two days after they met.
This is a fascinating case because it presents the distinction between a
patient’s right to refuse treatment and a physician’s assistance with
suicide. Legally, Diane possessed the right to refuse treatment, but she
would have faced a debilitating, painful death, so the issue of treatment
would be a moot point. It would be moot in the sense that Diane seemed to
refuse treatment because the odds were low, even if she survived she
would spend significant periods of time in the hospital and in pain, and
if she didn’t survive she would spend her last days in the hospital. If
Diane were to merely refuse treatment and nothing else (as the law
prescribes) than she would not have been able to avoid the death which
she so dearly wanted to avoid. However, what occurred was that Dr. Quinn
helped her to end her life, an already inevitable outcome, in a palatable
and peaceful manner.
“Diane taught me about the range of help I can provide if I know people
well and if I allow them to say what they really want,” wrote Dr. Quinn.
I think that Dr. Quinn walked a fine line, because I’m not sure if he
even committed an illegal act. While physician-assisted suicide (PAS) was
illegal in all 50 states when the article was published, he gave Diane
barbiturates under the pretence of helping her insomnia. However, I think
that regardless of the legal technicalities, Dr. Quinn demonstrated the
way that PAS works in an ideal situation. He had an established
relationship with the patient, so there existed a high level of trust
between Diane and Dr. Quinn. Furthermore, the communication between Dr.
Quinn and Diane was exemplary, and he did a fine job of involving her
family and speaking openly about the issue. Far too often, the wishes of
patient’s are not clear to the physician as evidenced by the SUPPORT
survey conducted amongst terminally ill patients. He allowed a patient to
make a reasonable, tenable choice, and in doing so increased the quality
of her life. Freed from the specter of a hideous death, Diane was able to
enjoy her final days here. Furthermore, I contend that Dr. Quinn was
acting according to the principle of beneficence, defined as “a duty to
help others further their important and legitimate interests.” The issue
of when and how she would die, seemed to be Diane’s most important
interest, and there can be little argument as to the legitimacy of that
interest. Additionally, this case can be interpreted to be in accordance
with the principle of nonmaleficence, the idea that one ought not to
inflict evil or harm to another. Some might argue that Quinn provided the
means for her suicide, thus hastening Diane’s demise and causing her
harm. However, Quinn was not responsible for her terminal illness, so
with a predetermined outcome, by allowing Diane to avoid a painful
demise, he acted in accordance with the principle of nonmaleficence.
It is my opinion that what occurred in the case of Dr Quinn’s patient
Diane is an example of good medicine. While the medical community neither
endorses nor recognizes physician-assisted suicide, this was a case where
the doctor provided the best care for a patient he could, seeking to
preventively alleviate her pain. In Quinn’s own words, “although I know
we have measures to help control pain and lessen suffering, to think that
people do not suffer in the process of dying is an illusion.” I also
recognize that it would have been better medicine, at least from a
palliative viewpoint, to aggressively treat the leukemia, and use
measures to control the pain. However, the decision to accept treatment
was not placed in Dr. Quinn’s hands and I believe he took the best course
available to him, in allowing his patient to exit the world peacefully.

				
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posted:8/24/2011
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Description: At the end of this series of treatments, the survival rate was 25%, and it was further complicated in Diane’s case by the absence of a closely matched bone-marrow donor. Diane chose not to receive treatment, desiring to spend whatever time she had left outside of the hospital.