DR. QUILL AND THE ACUTE LEUKEMIA PATIENT:
PERSONAL AND PROFESSIONAL ETHICS IN CONFLICT
Dr. Timothy Quill, a Rochester, New York physician, described in The New England
Journal of Medicine how he had prescribed barbiturates to help a patient kill herself. It
was the case of personal and professional ethics in conflict in the case of Diane, a long-
term patient suffering from acute myelomonocytic leukemia.
Diane had been a patient of Dr. Quill's for over 8 years. He had helped her overcome a
life-long battle with alcoholism and depression, and had seen her take control of her life,
realizing professional success and deepened personal ties to her husband, college-age
son, and several friends.
Dr. Quill chose to write up this experience in indirectly assisting Diane to take her own
life. Like others who are speaking out, he feels that the secrecy that was good practice
in another era may not be inappropriate for a public that is much better informed about
health care. 47 In an interview on National Public Radio, the Editor of The New England
Journal of Medicine conceded that the decision to publish Quill's article indicates that
the journal feels the issue of the physician's role in ensuring death with dignity warrants
more open consideration.48
Diane was a clear thinker, a good communicator, and an individual who had overcome
vaginal cancer as a young woman, At Dr. Quill's suggestion, she saw a psychologist
who confirmed that she was of sound mind. Dr. Quill, who once directed a hospice,
also had extensive discussions with Diane's husband and son about her illness and
options. After much deliberation with her family and Dr. Quill, she opted to forego any
treatment, deciding that the one-in -four change of recovery was not worth the pain
involved or the three-in-four risk of a painful death.49
During the time remaining to her, she wished to maintain control of herself and, when
that was no longer possible, to die in the least painful way. Since fear of a lingering,
painful death would prevent her from enjoying her remaining days, she requested
information on suicide. Dr. Quill referred her to the Hemlock Society. The following
week, when she came for a doctor's visit, she sought a prescription for barbiturates for
sleep. Dr. Quill made sure that she knew how to use the barbiturates for sleep, and
also the amount need to commit suicide. "I wrote the prescription with an uneasy
feeling about the boundaries I was exploring--spiritual, legal, professional, and personal.
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.
(Continued)
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