18 - Aid in dying

Summary

Case example

Dr. Quill has recently given his patient Diane some very bad news; a bone marrow biopsy shows that she has acute myelomonocytic leukemia. Diane owns a successful business, is married, and has a college-aged son. An oncologist informs her that treatment for her leukemia involves two courses of chemotherapy followed by whole body irradiation and stem cell transplantation, with a projected five-year survival rate of about 25 percent. Without treatment, life expectancy is less than six months. The oncologist recommends that she begin the chemotherapy immediately. To the surprise and dismay of her physicians, Diane refuses aggressive therapy for her condition, saying that the one-in-four chance of five-year survival is not good enough for her to undergo so difficult a course of therapy. Despite their efforts to persuade her to begin chemotherapy, she persists in her decision to live the rest of her life outside the hospital and to accept only palliative and hospice care.

Shortly thereafter, Diane tells Dr. Quill, who has been her primary care physician for the past eight years, that she dreads the thought of a lingering and painful death and very much wants to maintain control and dignity in her final days. She says that, when her condition gets worse, she wants to take her own life in the least painful way possible. She adds that she has discussed this at length with her husband and son, and they believe that they should respect her choice. Diane then asks Dr. Quill if he will help her take her life when her discomfort, physical deterioration, and dependence become too great. She tells him that having the means to end her life will free her from the fear of a lingering death and enable her to enjoy the time she has left.

How should Dr. Quill respond?

Key concepts

For more than half a century, the potential role of physicians in aiding the death of their patients has been one of the most controversial issues of health care ethics. Because “aid in dying” includes several different practices, and because commentators do not always use the terms that describe these practices in the same way, it is important to begin with definitions of suicide, physician-assisted suicide, and euthanasia. I define these concepts as follows: Suicide is the act of taking one's own life voluntarily and intentionally.