Case Study Physician Assisted Suicide

Diane: 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.