The patient's name was Debbie, and she was dying of ovarian cancer. After two sleepless days, she was struggling to breathe, vomiting repeatedly from a drug meant to sedate her. The resident physician on call was roused from sleep and summoned to her bedside in the night. The doctor had never seen the emaciated, dark-haired figure before. "It was a gallows scene, a cruel mockery of her youth and unfulfilled potential," the doctor wrote later. "Her only words to me were, 'Let's get this over with.' " The resident took her exhausted plea literally and instructed a nurse to prepare an injection of morphine, "enough, I thought, to do the job." Then, as a woman visitor held Debbie's hand, "I injected the morphine intravenously and watched to see if my calculations on its effects would be correct." Within minutes the 20-year- old woman was dead.
The doctor's unflinching account, published anonymously in the Jan. 8 Journal of the American Medical Association, was the first such confession ever to appear in a U.S. medical journal. With stark candor and dramatic detail, it spotlighted one of U.S. medicine's most controversial issues: the extent to which American doctors commit mercy killings. The report has prompted a storm of protest and a flurry of letters to J.A.M.A., most of which were from physicians who condemned the resident's behavior as both illegal and unethical. New York City Mayor Edward Koch was so horrified by the J.A.M.A. account that he asked the Justice Department to investigate. Last week the Illinois state's attorney's office in Cook County, where J.A.M.A. is published, informally asked the magazine's editors for the author-physician's name, which so far they have refused to reveal.
Across the country, physicians upset by the story criticized the unnamed resident's action. "Euthanasia is practiced," says Washington Internist Jon Wiseman. "But usually it's done in a more passive kind of way, by withholding treatment -- not by putting someone to sleep like a dog." Do doctors commonly make that kind of decision alone? "No one talks about that kind of stuff," he says. Manhattan Internist Eric Cassell, who prefers not to pass moral judgment on mercy killing, believes that if it does occur, it should be only because the "circumstances are impossible to change or bear -- not merely because the patient is depressed."
Few dispute that the story raised troubling questions about a practice that may occur in hospitals more often than most patients realize -- or most doctors are willing to admit. J.A.M.A. Editor George Lundberg says his own staff split over whether or not to publish the piece. But two medical peer- review panels urged him to publish it. Lundberg, who believes the anonymous account is genuine (though J.A.M.A. has made no attempt to verify it), decided to go ahead. "My intent was to produce vigorous debate on a timely topic," he says. "We are technologically capable of prolonging dying at great cost with little apparent benefit."