An anonymous first-person essay in a medical journal in which a doctor describes killing a dying cancer patient with a shot of morphine has touched off a growing controversy over questions of medical ethics and freedom of the press, a controversy complicated by doubt about whether the episode ever occurred.
The unusual situation first took shape in early January when the Journal of the American Medical Assn. published the four-paragraph essay under the headline, "It's Over, Debbie."
In it, the unidentified doctor ostensibly in the third year of a residency in obstetrics and gynecology recounts a middle-of-the-night episode in which he or she rushed to the hospital room of a young woman dying of ovarian cancer and ended her life after she said, "Let's get this over with."
While the essay has triggered another round in the international debate over euthanasia--the AMA now faces a subpoena from a Chicago prosecutor demanding the name of the physician author--even more basic questions have arisen about whether the essay is to be believed and why it was published.
Kirk Johnson, general counsel at the AMA's Chicago headquarters, said Thursday that even the journal's editors were uncertain whether the article was based on fact or fiction. He acknowledged, however, that the journal knew the author's identity, had communicated with him or her before the essay appeared and had confirmed that it was a specific physician.
Johnson and other top AMA officials have repeatedly emphasized that the association continues to vigorously oppose legalization of euthanasia and that the article--true or untrue--was published to stimulate discussion.
Fact or Fiction?
Dr. George Lundberg, the journal's editor, decided to publish the essay even though "there are differing opinions about whether or not it is a piece of fiction, whether it has some basis in fact and has some fiction or is completely factual," Johnson said. Lundberg, who had previously defended his decision to publish the essay, was instructed to stop commenting publicly on the controversy, Johnson said, after the subpoena was served on the AMA Tuesday.
In a prepared statement, the AMA said it "strongly condemns the conduct described in the essay. Indeed our ethical opinions specifically state that a physician should not intentionally cause death."
However, experts ranging from the national head of the Hemlock Society, the Santa Monica-based organization that advocates the right to strictly regulated euthanasia, to Alexander Capron, a USC medical ethicist who was executive director of a presidential commission on moral issues in care of the dying, question whether the essay may have been bogus, planted in the journal by advocates or opponents of euthanasia to sway public opinion. Their doubts focus on questions of hospital procedure described in the essay and on whether the amount of narcotic used could have been fatal.
The controversy has taken on further significance in the unrelated field of press law with the subpoena served by Richard M. Daley, the Cook County prosecutor who is the son of the late mayor Richard J. Daley. Johnson said the AMA will demand a formal court hearing on the subpoena early next week in which the association will argue that an Illinois state statute that allows reporters to keep their information sources secret also permits the AMA to refuse to identify the essay's author.
Lawyers nationally prominent in press freedom and source-protection issues agreed Thursday that the AMA is in a strong position. "While the case is exceptional in its drama," said James C. Goodale, a New York-based press law expert, "it is unexceptional in the principle that it raises. It really isn't any different than a garden variety source-protection case."
Floyd Abrams, another New York press law expert, noted that the first major American press freedom case ever litigated--over the right of John Peter Zenger, a New York printer, to publish a journal in the 1730s--dealt indirectly with the right of a publisher to keep secret the identities of authors. "The purpose (of the right of source confidentiality) is to allow editors and reporters to keep their promises," Abrams said. "I think the AMA journal is entitled to protection."
Unquestionably, the essay made a dramatic point almost immediately after its initial Jan. 8 publication. "The call came in the middle of the night," the essay began, relating how the doctor was roused from a sound sleep by a nurse to attend to "a 20-year-old girl named Debbie (who) was dying of ovarian cancer."
In a room on unit 3-North, the account continues, the doctor finds Debbie--in great pain and struggling to breathe--pitifully wasted in her bed, an 80-pound terminal victim dying an agonizing death. A woman friend allegedly stood next to Debbie, "holding her hand." "It was a gallows scene," the essay continues, "a cruel mockery of her youth and unfulfilled potential.
"Her only words to me were, 'Let's get this over with.' "
Waited for Her to Die