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Dying to Talk

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Recently in the Renaissance Room of the Hotel Inter-Continental, several hundred doctors and lawyers gathered to talk about putting patients to death. They also came to share secrets, confess, and grieve.

The conference--Physician Assisted Dying: Progress or Peril?, sponsored by the American Society of Law & Medicine--was intended to help these doctors and lawyers evaluate proposed legislation and professional guidelines on mercy killing and doctor-assisted suicide. It seems sad that doctors and lawyers congregate to talk about how the rest of us can choose to die.

The end of life often sets these professionals at each other's throats. In telling of their fears about ending patients' suffering, doctors said the threat of malpractice suits weighs heavily on them.

The lawyers said surprisingly little. One physician, sent by his hospital in Montreal, said the doctors were the ones who needed to talk. "Listen to the statements on policy," he said. "They may sound formal and bureaucratic, but behind each one is a doctor in moral agony, who can't sleep. Those who can rest with these kinds of decisions stayed home." The doctor, who cares for patients with ALS, or Lou Gehrig's disease, said he avoided describing the illness's symptoms to those recently diagnosed, afraid that if they knew their future they would ask him to hasten their death. When the disease's symptoms appear, he added, patients often prefer to die. Before coming to Chicago he had prescribed a heavy dose of morphine to a patient, which in effect let him drown painlessly in his own fluids. "I can't talk to people in my hospital about these issues," he told me. "No one will listen. You have to make your judgments with a macho disregard for the moral consequences--because if you bring them up with someone else, their attitude is likely to be, 'You're a doctor. It's your job. Stop complaining.' That's not so here. You can just feel the need to talk."

Doctors have few places to discuss their experiences. Plenty has been written about the philosophical and legal issues surrounding assisted dying, but so far most of the discussion of real cases has been offered anonymously through unsigned letters to medical journals or in articles that disguise patients' identities. Such accounts are widely read within the profession and have a powerful emotional impact. At the conference these famous cases were the starting point for discussion.

The best known, by Dr. Timothy Quill, ran in the New England Journal of Medicine last year. Quill, a physician in Rochester, New York, related his experience with "Diane," whom he described as "an incredibly clear, brutally honest thinker and good communicator" stricken with myelomonocytic leukemia. With chemotherapy she had a 25 percent chance of living, but would suffer terrible pain, disfigurement, and psychic trauma from the treatment. She asked him not to treat the disease but to ease her dying. Quill's article chronicled how he worked to limit her pain and how in the end he granted her request for the barbiturates he knew she would use to commit suicide.

Quill, a slight, bearded, soft-spoken man, addressed the conference, speaking of his terminal patients with some pain and resignation. He asked the audience to think about the deaths they had witnessed in their own families as the reference point for their decisions about terminally ill patients, saying that was the only way to put assisted deaths in the right perspective.

He said that since the appearance of his article he has become a magnet for tales about the suffering of the dying. He told the story of a formerly vigorous and well-to-do man who was struggling through his last months of cancer. The man's chief concern became how to die with dignity, and he asked his doctor to help him commit suicide. The doctor agreed, but the man changed his mind, afraid he would put the doctor in legal jeopardy. The man obtained a gun and tried to blow his brains out. "He failed," Quill said, eliciting gasps from the doctors. "He was taken to the hospital, where medical technology was put to work to save him." After a day of hellish pain for him and his family, he died, "only a few days sooner than he would have if the disease took its course." Quill told the crowd that he'd received similar stories from hundreds of families, many of them desperate for someone to tell them to.

Quill also hosted a workshop for doctors who needed guidance in talking to terminally ill patients. I tried to listen in, but was asked to leave so the doctors could feel free to speak openly. "Each one of the participants, like most of those at the conference, have probably had a case where they in some way helped a patient to his death," one doctor told me. "That is still something they need to hide."

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