Death and dignity: a case of individualized decision making

A physician's account is presented of the death of one of his patients, a woman named Diane whom he had treated for eight years prior to the illness that prompted the report. Diane had struggled with depression, alcoholism, and, earlier in life, cancer: now, from a position of personal strength and improved personal relationships, she was struck with the news that she had acute myelomonocytic leukemia, a rapidly progressing malignancy that is fatal if untreated. Upon hearing that her chances of survival, even with debilitating, painful treatment, were no better than 25 percent, she elected to forego chemotherapy. During the three months before she died, the physician met with his patient frequently, and discussed her options. She also held ongoing, honest discussions with her family. Diane was a strong believer in the importance of maintaining her dignity; she wanted to avoid excess pain and to die as comfortably as possible. Her request of the physician to write a prescription for sufficient barbiturates to commit suicide raised many significant issues for him; after he wrote it, they continued to meet regularly. Diane used her remaining weeks to deepen her relationships with her son, husband, and friends, but there came a time when the symptoms of her disease issued an imperative. After requesting an hour of solitude, her family returned to the room to find her lying at peace. The physician gave the cause of death as 'acute leukemia'; listing it as 'suicide' would have made Diane a coroner's case, subject to autopsy. The possibility existed that the family and physician would have been prosecuted. It is likely that suffering patients are often helped to die by family members and physicians; easing pain is not really the same as ending suffering. Profound questions are raised in the final paragraph of the report. (Consumer Summary produced by Reliance Medical Information, Inc.)