It's Over, DebbieThe call came in the middle of the night. As a gynecology resident rotating through a large, private hospital, I had come to detest telephone calls, because invariably I would be up for several hours and would not feel good the next day. However, duty called, so I answered the phone. A nurse informed me that a patient was having difficulty getting rest, could I please see her. She was on 3 North. That was the gynecologic-oncology unit, not my usual duty station. As I trudged along, bumping sleepily against walls and corners and not believing I was up again, I tried to imagine what I might find at the end of my walk. Maybe an elderly woman with an anxiety reaction, or perhaps something particularly horrible.
I grabbed the chart from the nurses station on my way to the patient's room, and the nurse gave me some hurried details: a 20-year-old girl named Debbie was dying of ovarian cancer. She was having unrelenting vomiting apparently as the result of an alcohol drip administered for sedation. Hmmm, I thought. Very sad. As I approached the room I could hear loud, labored breathing. I entered and saw an emaciated, dark-haired woman who appeared much older than 20. She was receiving nasal oxygen, had an IV, and was sitting in bed suffering from what was obviously severe air hunger. The chart noted her weight at 80 pounds. A second woman, also dark-haired but of middle age, stood at her right, holding her hand. Both looked up as I entered. The room seemed filled with the patient's desperate effort to survive. Her eyes were hollow, and she had suprasternal and intercostal retractions with her rapid inspirations. She had not eaten or slept in two days. She had not responded to chemotherapy and was being given supportive care only. It was a gallows scene, a cruel mockery of her youth and unfulfilled potential. Her only words to me were, "Let's get this over with."
I retreated with my thoughts to the nurses station. The patient was tired and needed rest. I could not give her health, but I could give her rest. I asked the nurse to draw 20 mg of morphine sulfate into a syringe. Enough, I thought, to do the job. I took the syringe into the room and told the two women I was going to give Debbie something that would let her rest and to say good-bye. Debbie looked at the syringe, then laid her head on the pillow with her eyes open, watching what was left of the world. I injected the morphine intravenously and watched to see if my calculations on its effects would be correct. Within seconds her breathing slowed to a normal rate, her eyes closed, and her features softened as she seemed restful at last. The older woman stroked the hair of the now-sleeping patient. I waited for the inevitable next effect of depressing the respiratory drive. With clocklike certainty, within four minutes the breathing rate slowed even more, then became irregular, then ceased. The dark-haired woman stood erect and seemed relieved.
It's over, Debbie.
--Name withheld by request
From A Piece of My Mind, a feature in the Jan. 8, 1988, issue of JAMA (Vol 259, No. 2). Edited by Roxanne K. Young, Associate Editor.
An anonymous essay in The Journal of the American Medical Association, describing the killing of a cancer patient by a resident physician, has astonished doctors and touched off a struggle between local prosecutors and the American Medical Association, which has vowed to protect the author's identity...
The local authorities are investigating the case because both the A.M.A. and The Journal are based in Chicago. The Cook County State's Attorney's office has issued a grand jury subpoena seeking all documents in the case, and the medical association filed a motion in Cook County Circuit Court today to quash the subpoena...
The essay, entitled ''It's Over, Debbie,'' does not indicate when or where the incident took place. Some physicians question whether the incident took place at all.
The essay appeared without explanation or comment in a section reserved for personal commentary called ''A Piece of My Mind,'' and was published, over the objections of several staff members, because of the topic's importance, said Dr. George Lundberg, editor of The Journal. A Disservice to the Profession
Dr. Mark Siegler, a professor of medicine and director of the Center for Clinical Medical Ethics at the University of Chicago, said the essay did a disservice to the medical profession by giving the appearance of sanctioning the physician's behavior. ''This could change medicine profoundly and irreversibly,'' he said. ''It undermines the profession if the public believes that doctors have the power to kill people, and occasionally do.''.,..
The editors found the article disturbing from the start. ''We were blown away,'' Dr. Lundberg said. ''It simply arrived in the mail like any other manuscript. We knew immediately that this was extremely important and worthy of serious deliberation.'' ...
The Journal agreed to publish the article anonymously, a decision that breaks with scholarly tradition but that is not unheard of at The Journal...
Opponents of mercy killing say the essay only underscores their fears and arguments.
''This is a perfect example of why this kind of conduct should not be legalized,'' said Giles Scofield, legal counsel for Concern for Dying, a patient's rights group based in New York. ''Some would say there is a fine line between the withdrawal of treatment and active euthanasia. This doctor clearly crossed that line.''
Advocates of euthanasia also found the essay troubling.
''We're shocked by the speed and spontaneity with which it happened,'' said Derek Humphry, founder and director of the Hemlock Society, a Los Angeles-based group that promotes voluntary euthanasia. ''People say, 'Let's get this over with,' when the doctor comes in to draw blood. That's not a request for death.''
Some physicians say the essay points up a problem in the training of residents. ''The cold, bitter anger in the essay makes you wonder, 'What are we doing in the socialization of our doctors?' '' said Dr. Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota.
''There was a quick inference, an irresponsible leap and no consultation with anyone else,'' Dr. Caplan said. ''It was horrific, but it ought not cast a pall over a discussion of mercy killing.''
Dr. Siegler said he considered the case an anomaly, and called it ''a personal failing that goes beyond the system.'' But he said he feared that the appearance of sanctioning active euthanasia could change the way doctors approach their work.
''If you go to the bedside of a patient and the option of killing the patient exists, as it did in the mind of this resident, doctors will be less inclined to think of alternative medical possibilities,'' Dr. Siegler said. ''It will change the mind and attitude of even the most conscientious doctors. And patients will be afraid that their doctor may be a great believer in death with dignity when all they need is their asthma medicine.''
See below. See Medicalization of suicide 9/18/15.