There is a doctor on the loose, in Illinois we think, who is either a gross fabricator or a killer. My guess is that he is a fabricator, in which case he need not go to jail, though he might consider a long sabbatical. The Journal of the American Medical Association must feel he is an honest killer or it would not have published his confession in its Jan. 8 issue.
The confession, an anonymous eight-paragraph essayette, recounts how he (or she) was awakened in the middle of the night to attend to a young woman whom he had never seen before and who was dying of cancer, painfully. Patient and doctor exchanged exactly five words -- "Let's get this over with," said she -- at which point doctor got 20 milligrams of morphine out of the nursing station and put the patient to sleep for good, as you would a cat. "It's over, Debbie," he writes. Signed, "Name Withheld by Request."
You may think I am overcondensing. I am not. I have skipped over the first two paragraphs, which tell us how tired and grumpy and resentful the resident is at being awakened; a technical description of the patient's labored breathing; reference to a mysterious older woman (patient's mother?) standing by, wordlessly watching and presumably blessing the goings on; and one line of perfunctory self-justification ("I could not give her health, but I could give her rest"). Otherwise, my precis captures the tone: curt, chilling, existentially chic.
Which is why I think the story, which has caused a furor, is a fraud. Not primarily because it is medically improbable -- the "alcohol drip" that the patient was supposedly getting for sedation is so eccentric a treatment that a former colleague of mine at the Massachusetts General Hospital reports having seen it exactly once in 14 years -- but because it is morally impossible. Not even the most progressive euthanasia enthusiast would mercy-kill this way. Only a psychopath would. And psychopaths are not known for their propensity to confess.
The essay does not even read like a confession. It reads like a self-conscious short story. And when the author is found (a Cook County prosecutor is now looking for him) or more likely when he reveals himself, he will take to the talk shows to describe how he made up this story to shake doctors out of their lethargy, expose society's hypocrisy about euthanasia, force people to confront the issue of death with dignity, etc., etc.
Rubbish. Even as a piece of didactic literature this fiction is a failure. Hard cases make for good ethics, and this is an easy case, so easy that, from the ethical point of view, it reads like a parody, a quiz of the name-six-things-wrong-with-this-picture variety. There are dilemmas about euthanasia, and this case does not present them. The doctor is barely awake. He does not know the patient. He does not talk to the patient. She does not talk to him. He interprets "Let's get this over with," as an instruction to kill her. (As one euthanasia activist told The New York Times, "People say, 'Let's get this over with,' when the doctor comes in to draw blood.") If he is killing her to try to alleviate her suffering, he makes no attempt whatever to alleviate her suffering short of killing her. (If she is vomiting continually because of the alcohol drip, then stop the alcohol drip, for God's sake, and try some other kind of sedation.) He consults no other doctor. He makes the terrible decision himself. Very lonely, very heroic, very modern. Very criminal. This is not mercy killing. This is existential murder, Meursault dressed in surgical gown and a pretense of compassion.
My implied criteria for "legitimate" euthanasia, which Dr. X grossly violated, are not made up. They come from the Netherlands, probably the most "advanced" country in the world on the question, where case law has set boundaries for permissible euthanasia. The Netherlands is a place where the High Court recently overturned the conviction of a doctor who lethally injected a 95-year-old patient upon her request. Where a state commission recommended (though parliament has not enacted) legalizing mercy killing by doctors. Where there are already an estimated 5,000 to 8,000 cases of euthanasia a year and where a survey of 25 general practitioners yielded nine mercy killings in 1985 alone. Even the Netherlands, hemlock haven, recently found two doctors guilty of murder, and sent one to jail, because they had not established beyond a doubt the will of the patient. Our guy never even asked!
In the United States, Dr. X has become, as eventually everything must in American life, a First Amendment case. A grand jury in Chicago has subpoenaed the Journal for documents, including the cover letter which would reveal who the murderer/dissimulator is. The American Medical Association, which publishes the Journal, is fighting the subpoena on the grounds that Illinois law protects editor-author privilege. The grand jury sits in Cook County because that is where the Journal is published. But no one knows where the act occurred, if it occurred at all. So the burning questions now are: Who has jurisdiction over the case? And how privileged is the editor-author relationship?
Perhaps this is the American way of making something of a bad situation: bad editorial judgment, bad ethical lesson, bad doctor. Maybe what we can salvage out of this is a good First Amendment case. And why not? Because as a murder case -- assuming this is not a hoax -- the case is too open and shut to be interesting.