A Better End Death: Doctor-assisted suicide is not the real issue, insists a physician at the forefront of that issue. The focus, he believes, should be on dying well.

December 27, 1996|By Linell Smith | Linell Smith,SUN STAFF

Almost from the start, Tim Quill was drawn to the dying, to the final days of life that can be so rich with meaning and so dark with suffering. Almost from the start, as a young medical student, he embraced the patients other doctors tried to avoid.

For Quill, death wasn't a defeat or repudiation of his skills as a doctor. Like birth, death was a journey. And over the course of two decades in medicine, Quill has come to see himself as a midwife to the process.

"The promise we make to our dying patients should have three parts," he says. "You won't die alone. You won't die in pain. And we will struggle together to face whatever has to be faced."

It is a promise he has spent a great deal of time explaining to his colleagues. On Jan. 8, his lawyers will explain it to the Supreme Court. Dr. Quill is a lead plaintiff in one of the most important, emotional cases to come before the high court in the coming year. The issue: Physician-assisted suicide.

In this country, the image of doctor-assisted suicide has become synonymous with Jack Kevorkian and his death machines, with brief, clandestine meetings between strangers, with bodies dumped at morgues.

Tim Quill, by contrast, is a 46-year-old, soft-spoken family man who has often known his terminally-ill patients for years. A former hospice director, he talks about death as a complicated process that can take place in small steps over a long period of time. Too often, he believes, the medical world fails the dying by substituting high-tech treatment for personal commitment. Helping people find a way to die well, he says, is as important as helping them fight for recovery.

"There should be nothing darker than the image of people who are so desperate that they go to Michigan to die in the back of a Volkswagen van at the hands of a pathologist after a meeting that lasts two hours," he says. "If that doesn't shake you up enough to say we've got to find a better way, then something's wrong."

The article was called "Death and Dignity, A Case of Individualized Decision Making," and it appeared in the New England Journal of Medicine on March 7, 1991. It was remarkable not only for its description of a doctor's decision to prescribe enough barbiturates to allow a dying cancer patient to take her own life, but also because the doctor identified himself: Timothy E. Quill, M.D., The Genessee Hospital, Rochester, N.Y.

Diane (a pseudonym) was a long-time patient and friend of Quill's. When the 45-year-old businesswoman was diagnosed with acute leukemia, Quill was the one who had to tell her. And he was the one who helped her make decisions about how to respond to the deadly disease. Diane chose hospice instead of aggressive treatment. She clung to life throughout extreme bone pain and months of comfort care before she finally decided to take the pills she had stockpiled with Quill's help. She was careful to die alone so that no one could be accused of helping her commit suicide.

Quill's account of her death was straightforward and clinical in tone. He didn't try to capitalize on its natural drama; nor did he reveal much about his emotions as he watched Diane's deterioration.

Nevertheless, the article provoked an avalanche of reaction. Though other doctors help patients end their lives, physician-assisted death remains a secret practice that few would risk their careers to speak about publicly.

Quill received more than 1,500 letters -- "98 percent" in support of what he did, he says.

"A lot of them included very moving personal stories which made me realize I had tapped into some very strong experiences people had had [with the death of loved ones] and often not talked about."

Prosecutors, however, took a harsher view. Quill was summoned to appear before a grand jury, though it found no reason to indict him.

"I underestimated pretty severely the impact of what I was doing by publishing this," Quill says. "Much of the response was, 'Doctors must not kill. Who is this doctor? Get rid of him!' Before I published the piece, I asked some academic lawyers, 'Am I doing something foolish?' They said, 'You will never be successfully prosecuted.' But what they didn't tell me is that you can go through an intense process not being successfully prosecuted."

The decision to speak candidly about assisted suicide changed Quill's career. Though he still teaches at the University of Rochester and practices primary-care medicine, he has become one of the nation's most eloquent spokesmen for relieving the suffering of the terminally ill.

His testimony helped dying patients in New York who were not on life-support systems win the right to end their suffering with the help of doctor-assisted suicide. The Supreme Court will hear the appeal of this ruling along with another from Washington state.

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