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Lundberg's own position reflects the A.M.A.'s posture on euthanasia: physicians may withhold life-sustaining treatment under certain circumstances, but should never intentionally cause death. Most physicians concur, though some acknowledge that the line is often hard to draw. Perhaps the harshest indictment of Debbie's treatment comes from doctors who maintain that morphine, used properly, could have kept her comfortable. Her regular physicians, not the hapless resident, believes Minneapolis Neurologist Ronald Cranford, are the "real criminals" for having failed to prescribe adequate medication for her pain. But if the dose required to bring relief also happened to hasten the end of her life, that is something a physician could live with. Pediatrician Kathleen Nolan, an ethicist at New York's Hastings Center, reports that several of her young patients, suffering terribly from cancer, died in this way. Says Nolan: "There is no dishonor."
The J.A.M.A. account of Debbie's death also underscores a fact of medical life: terminally ill cancer patients often suffer unnecessarily because doctors hold back narcotics for fear their patients will become addicted -- even when they have only weeks or months to live. This casts doubt over the profession's reassurances that pain will be controlled. And the dread of unrelenting pain is one factor that may encourage patients and doctors alike to blur the line between letting death occur and causing it.
Some doctors are wary of outside intrusions into an area that has so long been their province. Says Lundberg: "There are many physicians, myself included, who believe that the place where life and death decisions should be made is at the bedside, between the patient, family, doctor and, if appropriate, a religious representative, and that there's no place for the courts in this decision." Even so, if Debbie's bleak saga yields any lesson, it is that some physicians may need more help and guidance in navigating the murky area between unending pain and death.