"A Midwife Through the Dying Process," by Timothy E. Quill, Johns Hopkins University Press. 239 pages. $24.95
It's hard to argue with one of the more memorable contentions of this book: No one should have to die with a plastic bag over his head. (The Hemlock Society recommends the bag as a suicide backup measure if an overdose of barbiturates doesn't do the job.) But by logical extension, in Dr. Timothy Quill's vaguely Orwellian version of compassionate medical care, terminally ill patient who wishes to hasten death should have sanitized, clinical protocols available - and physicians should have not only the freedom, but the responsibility, to administer them. That's just one of the troubling tenets presented by Quill, whose efforts to legitimize physician-assisted suicide in dire circumstances have made him something of a thinking man's Kevorkian.
Quill, a practicing physician and former hospice director, has made his case in prestigious medical journals and a previous book, "Death With Dignity." His admission in 1991 that he provided barbiturates to an avowedly suicidal leukemia patient landed him before a grand jury, although he was never charged. Here, he presents nine heart-rending case histories to illustrate his philosophy: namely, that physicians must be "forthright" and "creative" in helping patients die in peace and comfort, on their own terms. Anything less, he insists, is medical abandonment.
Anyone who has ever seen friend or family member kept wretchedly alive by "heroic" life-support measures will empathize with the sentiments beneath Quill's crusade, even when he pushes the envelope of currently acceptable ethics: for example, advocating the option of voluntary dehydration (withholding food and water) under heavy sedation. But the book's tone and content both leave one uneasy. The language veers between euphemism and frankness. The case histories exude self-congratulation, as the humble yet enlightened doctor builds trusting relationships with a diverse and challenging series of dying patients.
Nor does Quill ever hint at any moral underpinnings beyond patient autonomy and the relief of suffering. He repeats the sad observation that "personhood" may "disintegrate" under the onslaught of terminal illness. Presumably, he defines personhood being conscious, comfortable, and able to communicate; life itself apparently holds no absolute or innate value.
Those who oppose all or part of the gamut of physician-assisted dying warn that certain populations will be highly vulnerable to abuses (the elderly, severely handicapped, uninsured and terminally costly). Quill dismisses these concerns in a few paragraphs of prescribed "safeguards." He makes admiring mention of the euthanasia-friendly Netherlands, but gives no hint of recent reports of abuses despite Dutch safeguards.
Quill doesn't reveal his own spiritual beliefs about death and the afterlife, but he tips his hand now and then. A faint vein of hostility to traditional Judeo-Christian values pervades the book. black AIDS patient fears being shunned by her fundamentalist church; a devout Roman Catholic, in agony, considers suicide but recalls it is a mortal sin. By contrast, Quill enthuses over the comfort derived by several patients from Buddhism, Native American drumming and New Age music - none of which present stumbling blocks to the relief of mortal misery. Modern technological medicine creates devil's bargains in hospitals every day; just watch out for the guardian angels.
Brenda L. Becker is a medical writer and editor for consumer and clinical magazines, including Woman's Day and Patient Care, co-author of "Week by Week to a Strong Heart," a two-time winner of national awards for writing on cardiovascular disease; and a contributor to journals of opinion including the American Spectator and National Review.
Pub Date: 12/08/96