DR. QUILL AND THE ACUTE LEUKEMIA PATIENT:
PERSONAL AND PROFESSIONAL ETHICS IN CONFLICT
(Concluded)
In the next few months, Diane spent a lot of time with her college-age son, who
stayed home from college, her husband, who opted to work at home, and closed
friends. But as bone pain, weakness, fatigue, and fevers began to dominate her
life, she contacted close friends and asked them to come over to say good-bye. In
a tearful good-bye to Dr. Quill, she said "she was sad and frightened to be leaving,
but that she would be even more terrified to stay and suffer."54 Two days later, she
said her final good-byes to her son and husband, and asked to be left alone for an
hour. An hour later, they found her on the couch in her favorite shawl, at peace at
last. They mourned the unfairness of her illness and premature death, but felt that
she had done the right thing, and that they were right to cooperate with her in her
resolve to attain control over health care decisions, and to attain a death with
dignity.
Dr. Quill concludes, "She taught me that I can take small risks for people that I
really know and care about" by helping indirectly to make it possible, successful,
and relatively painless. "I wonder" he asks, "how many families and physicians
secretly help patients over the edge into death in the face of such severe
suffering? 55
(a) It is felt by many ethicists and experts that in many ways, Dr. Quill
"has significantly advanced the debates over doctor-assisted suicide."52 Dr. Quill
advised his patient to see a psychologist to ascertain that she was of sound mind. He
also had extensive discussions with Diane's husband and son about her illness and
options. And, he had known Diane for over 8 years. His, in a sense, is a model case.
(b) Dr. Quill had the advantage of having known his patient over many
years. In this day and age, when patients often change doctors, when can a doctor
safely say that he or she really knows the patient? There are no rules for doctor-
assisted suicide. It is still officially considered a violation of professional ethics that can
mean the loss of one's medical license.
b. Moral Imperative vs Self-Interest. How does a physician reconcile his or
her personal ethics with the professional code of ethics? Is human life valuable, no
matter what the quality of that human life? Is that an unconditional moral imperative
(requirement) without exception? Or does the individual's right to self-determination and
a quality of life override the sanctity of life issue? Are these two equally valid
imperatives (the value of all life vs. self-determination/ quality of life)? Or is the quality
of life/self-determination issue a matter of self-interest? The official stance is the latter--
all life has value, no matter what the quality of that life. The issue of self-
determination/qualify of life is considered to be a matter of personal self-interest.
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