ABC, Thursday, March 25, 9 p.m.
Episode" "Suicide is Painless"
The premise: At Seattle Grace Hospital, patient Kim Allen ( Sara Gilbert) is suffering from stage IV (widespread) large cell lung cancer that has spread to her lymph nodes and her liver. She has had repeated pleural effusions (fluid has built up in her lungs, which she has had drained), and she continues to have difficulty breathing. She is in constant pain and is told that she has less than six months to live.
FOR THE RECORD:
Unreal World: In the April 12 Health section, a column about an assisted suicide on "Grey's Anatomy" said that a patient had been sent home with a prescription for barbiturates. In fact, the patient in the episode took the barbiturates and died in the hospital. —
Allen has been offered hospice care with its attempts at pain relief and heavy sedation, but she is considering physician-assisted suicide instead. A psychologist has declared her mentally fit, and she asks her doctor, Dr. Teddy Altman (Kim Raver), to help her die. She seems open to the possibility, but in Washington state, according to the show, physician-assisted suicide is legal only if two physicians agree and the request is made by the patient twice, 15 days apart.
The second doctor who is asked to evaluate her, Dr. Owen Hunt (Kevin McKidd), is reluctant to approve her request. Finally, with both Altman and Hunt in agreement, Allen is sent home with a prescription for barbiturates, which Altman tells her will stop her breathing 45 minutes after she takes them.
The medical questions: Is stage IV large cell lung cancer usually terminal in less than six months or can it still be treated successfully with chemotherapy? Can a patient with extensive lung cancer be made comfortable with the help of sedation, pain medication and hospice care — without rendering her unconscious or stopping her breathing? Is physician-assisted suicide legal in Washington state provided that two physicians agree and the patient is mentally competent? Are barbiturates usually prescribed for use outside the hospital in such a case? Could a dose be determined that would predictably stop a patient's breathing in 45 minutes?
The reality: Chemotherapy can sometimes extend the survival of stage IV large cell lung cancer patients beyond six months, but it is often ineffective. The median time to death is eight months, says Dr. Joseph Lowy, medical director of the Palliative Care Service at NYU Langone Medical Center. Only 20% to 30% of patients are alive at one year, so the show's prediction of less than six months for Allen is fairly realistic.
Sedation, pain medication and hospice care can make such a patient comfortable, but shortness of breath can be a particularly difficult symptom to treat, says Dr. Timothy E. Quill, professor of medicine and psychiatry at the Center for Ethics, Humanities, and Palliative Care at the University of Rochester School of Medicine in New York. A patient might be suffering and not be able to report it because they are heavily sedated, Quill says.
In physician-assisted suicide, a physician generally evaluates the patient and then prescribes potentially lethal medication that the patient then takes (or not) by his or her own hand. It has been legal in Washington state since March 5, 2009, and yes, two physicians must agree on the prognosis (that the patient will die within six months), the competence of the patient and the voluntary nature of the request. "There must be no acceptable alternatives," Quill says.
Evaluation by a psychologist or psychiatrist is not required, says Dr. Shawn J. Skerrett, professor of pulmonary medicine at the University of Washington, adding that he's uncomfortable participating in physician-assisted suicide, in part because of "the lack of a requirement to exclude depression by a mental health professional."
Barbiturates are the most common medication prescribed for this use. Data from Oregon indicate that the drugs are consistently effective, but some research suggests that assessing the proper dose can be problematic. In 2009, for example, 36 patients took lethal doses of prescribed medication under the Washington state Death With Dignity Act. In six cases, death took more than 90 minutes.
Siegel is an associate professor at New York University's School of Medicine.