Death and Dignity
Jordan, Patrick
BOOKS 'Comfort care options' imothy Quill is the sort of competent, compassionate physician one would hope to find for oneself. Besides having a private practice in upstate New York, Quill...
...The fictional book within a book provides the underlying conceit for The Dork of Cork, an enchanting novel by Chet Raymo, a professor of physics at Stonehill College in Massachusetts, a science columnist for the Boston Globe, and the author of 365 Start3, Nights and The Soul of the Night...
...Death probably won't object, but care-givers ought to know and do better...
...It is a prerogative too many already feel is theirs...
...When death comes before its time, some of life's best and most important moments are lost...
...Although he was not physically present at Diane's suicide, ~3 la Michigan's Dr...
...The case of Diane was formative for Quill and serves as the leitmotif of Death and Digni...
...Unlike Kevorkian, however, Quill projects no Strangelovean image...
...It is because of my deformity that the publisher has such confidence in the marketability of my book," Frank is compelled to add...
...By turning even the word "vital" on its head, Quill has effectively delegated physicians as the final arbiters of power and control...
...Rather than "abandoning" (a word that appears often in the book) the patient at the final stage, Quill argues, the doctor ought to facilitate as smooth an end as possible...
...A LONG VIEW, A SHORT MAN THE DORK OF CORK Chet Raymo Warner Books, $18.95,354 pp...
...Quill's NEJM piece was an attempt to explain his actions and to legitimate them before the medical profession...
...In the United States, if you can't make your own choices and can't control your own destiny, you have, in effect, lost much of the impetus for living...
...Death and Dignity is a strictly utilitarian argument driven by sentiment...
...For Quill, as for the medical profession in general, the role of the physician is to be a provider: to facilitate, to heal, to enable, but never simply to stand by...
...He states that Diane "taught me about the range of help" he could provide patients in similar circumstances...
...to the splendor of comets and constellations and lunar eclipses, which he studies from his rooftop in a down-at-the-heels section of Cork, Ireland...
...But is this actually the case, and if it is, does it need to be...
...Quill's other euphemisms for physician-assisted suicide include "a controlled death" and a "nonviolent death...
...In fact, she was dead-from the overdose he had provided...
...Quill never attempts a full-scaled moral or theoretical argument for the legalization of physician-assisted suicide, never questions whether human life has value other than what we ourselves decide to give it...
...Besides having a private practice in upstate New York, Quill teaches at the University of Rochester School of Medicine and Dentistry and occasionally contributes to the prestigious New England Journal of Medicine...
...When that happens, we and our loved ones are all diminished...
...He writes, for example, that "physicianassisted suicide should never be contemplated as a substitute for comprehensive comfort care" (his term for pain management for dying patients...
...This fastidious American tourist keeps turning up on Hepburn's European holidays, making sure that everything is sprayed with Lysol and looks as neat as Disneyland...
...Instead, he relies on anecdotes, mostly from his own practice...
...For as long as he can remember, Frank has looked to the night sky for company...
...We meet Frank when he is on the verge of great fame, having written a much-anticipated memoir, soon to be published by Penguin...
...Patrick Jordan highly regarded by his peers...
...Neither of these investigations led to actual charges being filed, however, and Quill remains in good standing...
...As an adult, he finds the prospect of romance--or for that matter, any sexual encounter--unlikely...
...While Quill states that tough cases do not make good law, the thrust of the book is clearly the opposite...
...She told me that when it came to untreatable pain, she had run into such instances about once every five years...
...With the publication of his book, he is likely to become a sought-after guest on the talk-show circuit as well...
...Death and Dignity begins with a reprint of Quill's 1991 NEJM article, "Death and Dignity: A Case of Individualized Decision Making...
...As the former director of a hospice program, he seems to combine a commendable measure of medical expertise with a compassionate bedside manner...
...Facilitating such timely and compassionate deaths, he says, ought to be considered "a fundamentally vital role for physicians...
...Instead of the patience and dedication such a course of treatment--already available-relies on, Drs...
...Allowing" death, however, is something decidedly different from actively facilitating it, which is what Quill is proposing...
...I am reminded of a semicomic character in the Audrey Hepburn film, Two.fi)r the Road...
...In reporting Diane's cause of death, Quill had not indicated it was from an overdose...
...What dissuades most of this nurse's patients from calling for a final, magic bullet...
...Range of help" may be a Hallmarkean improvement on the term "physician-assisted suicide," but at least the latter is not misleading...
...But a few pages later he shifts smoothly to different terrain, arguing that physician-assisted suicide should be considered "part of a continuum of comfort care options...
...When I arrived at their house," he writes, "Diane indeed seemed peaceful...
...Thus, Quill says, "allowing someone a peaceful, dignified death can be a very sad, loving gift...
...In that piece, Quill told the story of"Diane," a middle-aged, longtime patient of his who suddenly developed acute myelomonocytic leukemia, a rampant, painful, and terminal condition...
...Quill and Kevorkian want to force the hand of death, to speed up its house calls...
...Months later, Jack Kelly, the immigration officer who first interviewed Bernadette, sees her on the street and attends to her baby's birth: "...the midwife pulled from Bernadette's womb the unfortunate child, a squashed sort of thing Commonweal 16 July 1993:23...
...Eventually, Diane did take her life, overdosing on barbiturates...
...He not only wishes to relieve the individual dying patient from a prolonged and agonizing death, but to free society from what are now its most conflicted and anguishing questions about the end of life...
...This history includes his peculiar upbringing by a distant, troubled mother who, as a child, witnessed an unspeakable tragedy in Ig Nazi-occupied France...
...Set almost entirely in and around Cork, Frank begins his story at the end of World War II, when he is conceived by his stowaway French mother, the beautiful Bernadette, aboard a U.S.-bound troop carrier which stops in Cork Harbor for provisioning...
...Why then is he someone to be uneasy about...
...Clare Collins ~ rank Bois is a dwarf, 43 inches tall and 43 years old...
...Also central to his tale is the influence of three men, his mother's lovers, who become, at various times, his surrogate fathers...
...If at the end of life the patient has had enough of anguish, pain, or despair, the role of the physician ought to be that of an agent who, in Quill's terms, helps the patient "over the edge into death...
...Instead, he relies on vignettes and the recollection of hard deaths he has witnessed to ease the reader toward his desired end...
...Quill provides no statistics, offers no surveys of hospitals, hospices, or nursing homes...
...The appeal and the danger in Quill's book is its combination of this blessed rage for order 22:16 July 1993 Commonwealand tailored endings and his application of just-the-right-dose of "compassion...
...Jack Kevorklan-from whom Quill is at pains to distinguish and distance himself in the book--the publication of Quill's article led to his eventual investigation by the New York State Health Department and by a grand jury...
...Quill's language is consistently beguiling and misleading...
...I asked a nursing supervisor who has worked with terminally ill cancer patients full-time over the last fifteen years what her experience had been...
...Quill's aim is to translate his experience with Diane into a model for legalizing physicianassisted suicide...
...Compassionate care, for her, necessarily implies and includes skilled pain management...
...A recent Catholic Health Association publication, "Care of the Dying: A Catholic Perspective" (The Catholic Health Association, Saint Louis), does provide some disheartening figures, ones Quill might have liked to quote...
...If that is the case, Quill's argument hardly amounts to a persuasive reason to legalize euthanasia-on-demand...
...A doctor who is steeped in this culture and who has already run out of technological fixes, will see little reason to persuade a patient to fight on longer...
...Apprehended by immigration officials, Bernadette manages to escape into the streets of Cork, making the city her home...
...The book's subtitle, "Making Choices and Taking Charge," combines two powerful political lodestars...
...Seldom has the slippery slope been negotiated so adeptly...
...In a society that sees little earthly reason for enduring physical (or mental) suffering, and which fears "the loss of control" over one's life as a fate worse than death, Quill's radical medicine will go down relatively easily...
...His book gives the answers...
...In the course of the book, Quill consistently argues from the particular--and the painful--to the general, with an eye on fiwmulating public policy...
...He seems eminently reasonable and reassuring--up to a point...
...Called Nightstalk, his book is, he tells us, "a work on the night sky, descriptive and poetic, with a generous lacing of personal history...
...He begins by claiming that cases such as Diane's are not the exception but the rule...
...Unlike Kevorkian, Quill seems to be DEATH AND DIGNITY Making Choices and Taking Charge Timothy E. Quill W. W. Norton, $21.95,255 pp...
...As mentioned before, Quill stakes out his main premise early on: "Untreatable suffering prior to death is unfortunately not rare...
...Compassionate care makes them feel valued," she says...
...The study says that nearly 25 percent of cancer patients "die with severe, unrelieved pain...
...But the study then examines the reasons for this sad statistic--including doctors' lack of pain-management skills--and offers a wide range of practical policies and medical modalities that would dramatically lower it...
...Isolated by his deformity, Frank has led a solitary, lonely life...
...At her request, Quill provided Diane with the know-how and the means to take her own life, should she decide she could no longer continue to live as she desired...
Vol. 120 • July 1993 • No. 13
