Life-and-Death Dilemma

Doctors and laymen alike were shocked and outraged at an anonymous letter in the January 8th issue of the Journal of the American Medical Association. In the letter, a resident physician wrote in, describing how he had been summoned to the bedside of a 20-year-old patient named Debbie, who was dying of ovarian cancer.

She was struggling to breathe, vomiting repeatedly because of her sedatives. "It was a gallows scene, a cruel mockery of her youth and unfulfilled potential," the resident wrote. Finally, Debbie managed to say to the resident, "Let's get this over with." The resident took her plea literally and injected a dose of morphine, "enough, I thought, to do the job." His "calculations" were correct; within minutes Debbie was dead.

The unknown resident's actions points to the serious moral and ethical questions of euthanasia. What has upset many doctors is the resident's decision to kill Debbie without attempting to allieviate her pain or without consulting her doctor or family. The American Medical Association's official guidelines say that physicians may withhold life-sustaining treatment under certain circumstances, but should never cause death intentionally. But as Debbie's case shows us, the line between the two has become fuzzy.

This ambiguity has led to the case's controversy, which has swept waiting rooms and operating rooms across the country. Unfortunately, the AMA never spells out the "certain circumstances" under which euthanasia is condoned. What's the difference between an "intentionally caused" death and a death caused when life-sustaining treatment is withheld?

What about an individual's freedom of choice? Most doctors believe that a patient under great pain should not have power over his own life, but that the choice should be left up to the doctor and the family instead. Under this theory, the resident in Debbie's case overstepped the bounds of his responsibilities as a physician. Debbie's ambiguous statement, "Let's get this over with," may not have meant that she wished to die but instead could have referred to a different treatment.

A consideration of equal importance in life-and-death decisions has to be the patient's quality of life. Will a few more hours, days, or even months of mere existence in either pain or complete unconsciousness really add to the life of the patient or his family? Some may be horrified at this attitude. Some even think that making such judgements is akin to playing God. But we have moved toward God-hood by prolonging life by artificial means--should we therefore stop using respirators, mechanical hearts and lungs, and kidney machines? Advances in medical science have brought with them the ethical responsibility of deciding life or death.

But the question of whether to end life should not have been dealt with in the hasty way that Debbie's resident did. A doctor's first priority (remember the Hippocratic oath) is always to save life--the problem is in defining what life is and whether a patient has any choice in ending it. The AMA must take a stand and establish a clear definition of life, and under what circumstances a physician can withhold life-prolonging treatment. Unless such guidelines are laid down, a tragic occurrence such as Debbie's induced death may again occur through the efforts of other "well-meaning" physicians.