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It all began with a 1991 article in the New England Journal of Medicine.
The author, Dr. Timothy Quill, had used this public forum to explain his reasons for assisting a 45-year-old terminally ill leukemia patient, whom he only referred to as “Dianne”, to end her life. Quill, a Rochester, New York physician, was a professor of medicine at the University of Rochester School of Medicine and Dentistry as well as associate chief of medicine at the Genessee Hospital. He had been treating “Dianne” for eight years though aggressive cancer treatments did nothing more than prolong the pain she was experiencing.
While Dr. Quill had advised Dianne about the remaining options open to her, including chemotherapy and bone marrow transplants, she declined them all due to the limited chance for success and the debilitating side effects involved. She had already seen the brutal effect of chemotherapy on other family members and friends who had undergone it and feared what her own protracted death would do to her family. Instead, after agonizing discussions with Dr. Quill and her own family, she asked his help in ending her life peacefully at home. While Dianne told Dr. Quill about her own sense of outrage over physician-assisted suicide being illegal, she knew that getting his help would be difficult. He suggested that she contact the Hemlock Society, a national organization that advocates for terminally ill patients seeking to end their own lives as an end to pain. Founded in 1980, the Society is dedicated to providing terminally ill patients with information on death and also advocating the legalization of physician-assisted suicide.
Based on the information she received, including different methods by which she could end her life, Dianne asked her doctor to prescribe barbituates for “insomnia” though both she and Dr. Quill were aware of their potential use to commit suicide at a time of her own choosing. Along with being powerful central nervous system depressants, barbituates are also potentially lethal when taken in high doses (and have been used by some U.S. states for executing convicts in capital punishment cases). After numerous meetings with Dianne and her family to discuss the ethical questions involved, Dr. Quill then arranged to have her talk to a psychologist to ensure that she not motivated by depression and understood the full implications of what she was requesting. Based on the psychologist's findings, he then prescribed the barbituates and told Dianne how much would be needed for a lethal dose.
When Dianne’s illness grew worse, her suffering increased as well. Her friends and family, along with Dr. Quill, did everything they could to care for her but it wasn’t enough. Just days after the barbituates were prescribed, Dianne finally decided to end her pain by taking the lethal dose alone. In reporting her death to the medical examiner, Dr. Quill reported the cause of death as acute leukemia without mentioning suicide to avoid any police investigation.
As you might expect, Dr. Quill’s public admission to assisting a suicide provoked a major legal and media firestorm. Interviewed in 1991 by the New York Times, he stated that he had never assisted a patient to commit suicide before or since but he was aware of other cases in which doctors had hastened death at a patient's request. Timothy Quill was invited onto all of the news-related programs that were exploring the question of physician-assisted suicide. That included “Dateline”, “20/20”, and “Nightline.” He also reprinted his journal article in his first book, Death and Dignity: Making Choices and Taking Charge, which was published in 1994. This book also included vignettes featuring other terminally-ill patients as well as information on the Hemlock Society and how to cope with death and dying.
Though his public revelation of assisting in a suicide stunned the medical community, Timothy Quill was never charged for his role in Dianne’s death. Still, the question of physical-assisted suicide remained given New York legislation that makes it a crime to give lethal drugs to dying patients. While no physicians have been prosecuted under this legislation, the penalty for a successful conviction can be as much as four years in prison.
At the same time, Michigan pathologist Dr. Jack Kevorkian was already making headlines for his own advocacy of physician-assisted suicide (though Kevorkian was not a treating physician, his involvement in patient suicide would later lead to his second-degree murder conviction in 1999). It was the mixed reaction to Kevorkian's crusade, as well as the active opposition to physician-assisted suicide in many U.S. states that convinced Quill to publish his article.
Legal cases began springing up in different states, beginning in Washington, to challenge the constitutionality of laws banning physician-assisted suicide. This would eventually set the stage for the groundbreaking Quill vs. Vacco legal decision in 1997.
Soon after the 1991 article came out, Timothy Quill and a coalition of doctors and terminally-ill patients filed suit to have New York's ban on physician assisted suicide overturned. The suit specifically named New York's then-Attorney General Dennis Vacco and argued that the law violated the Equal Protection Clause of the Fourteenth Amendment. In other words, if patients could refuse potentially life-saving treatment, why couldn't they receive active assistance from their doctors to end their lives?
When the District Court ruled in favour of the New York legislation, the decision was overturned on appeal and the question was eventually passed on to the U.S. Supreme Court. Finally in a rare 9-0 legal decision, the U.S. Supreme Court ruled to uphold the state's right to protect patient life and had a compelling interest in opposing physician-assisted suicide. Still, the decision also left the door open for individual states to pass laws allowing physician-assisted suicide In handing down the ruling, the Court recognized that terminally ill patients have a constitutional right to medication to ease their pain, even if their death might be hastened in the process. The Supreme Court justices concluded their decision by stating “Americans are engaged in an earnest and profound debate about the morality, legality and practicality of physician-assisted suicide. Our holding permits this debate to continue, as it should in a democratic society.”
In the meantime however, the fight to allow physician-assisted suicide was being won in other states. In Oregon, for example, the passage of the Oregon Death With Dignity Act in 1994 legalized physician-assisted suicide (with certain restrictions). According to the Oregon act, physicians could prescribe medication for ending a life though patients needed to take the medication themselves. Patients also needed to be Oregon residents to prevent "suicide tourism" by patients from other states seeking to end their lives. Other states that have enacted similar laws include Washington, Vermont, and possibly New Mexico depending on the success of a recent court case.
But physician-assisted suicide has also become a major issue in other countries as well. Although Belgium, the Netherlands, and Luxembourg have all passed laws allowing assisted suicide under specific conditions, other countries continue to grapple with the complex legal and moral issues involved. This has led to the establishment of "suicide clinics" in countries such as Switzerland though their legal status is still being questioned.
In my own country, Canada, the ban on physician-assisted suicide has just been struck down with the historic Carter v Canada decision by the Supreme Court of Canada. Since the Federal government has been slow to respond (and has actively opposed physician-assisted suicide in the past), it is still unclear at this point whether the current government will be tackling this issue in an election year. In all likelihood, this issue will ultimately be left up to individual provinces to deal with on their own.
As for Timothy Quill, he remains active in the palliative care movement and the American Academy of Hospice and Palliative Medicine included him in their list of 'Hospice and Palliative Medicine Visionaries' in 2013. At this time, physician-assisted suicide is still illegal in the state of New York.
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