Death and dignity: a case of individualized decision making

Article Abstract:

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.)

Physician and patient, Physician-patient relations, Euthanasia, editorial

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The rule of double effect: a critique of its role in end-of-life decision making

Article Abstract:

The rule of double effect, often used to guide clinicians in making end-of-life treatment decisions, fails to consider some important aspects of ethical decision-making. The rule judges morality based on intent. Medication for pain relief would be moral even if it causes a patient's death. Medication intended to cause death would be immoral. The rule ignores the desires of the patient, and does not recognize the ambiguities of human intent. Absolute prohibition against causing death may prevent physicians from acting morally in decisions of pain management and treatment withdrawal.

Analysis, Terminal care, Medical ethics

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The Million dollar question

Article Abstract:

The right given to the patient and their family to terminate a patient's life is being portrayed wrongly in many movies and in real life. 'The Million Dollar Baby' is one such film in which the patient ignores the medical assistance to terminate herself and instead chooses to kill her self unsuccessfully, only to live with guilt, shame, and isolation that followed.

New England States, Evaluation, Criticism and interpretation, New England, Patients' rights, Million Dollar Baby (Motion picture)

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