Officials of the association, while saying they condemn the conduct described in the essay, are resisting the subpoena on the the ground that an Illinois press shield law prohibits a court from ordering disclosure of privileged information unless the court finds that all other sources have been exhausted.
The essay, entitled ''It's Over, Debbie,'' does not indicate when or where the incident took place. Some physicians question whether the incident took place at all.
The essay appeared without explanation or comment in a section reserved for personal commentary called ''A Piece of My Mind,'' and was published, over the objections of several staff members, because of the topic's importance, said Dr. George Lundberg, editor of The Journal. A Disservice to the Profession
Dr. Mark Siegler, a professor of medicine and director of the Center for Clinical Medical Ethics at the University of Chicago, said the essay did a disservice to the medical profession by giving the appearance of sanctioning the physician's behavior. ''This could change medicine profoundly and irreversibly,'' he said. ''It undermines the profession if the public believes that doctors have the power to kill people, and occasionally do.''
Kirk Johnson, general counsel to the A.M.A., said the association had gone on record as opposing active euthanasia and that, although the association's board of trustees endorsed the editor's decision, neither the essay nor The Journal represented the association's opinions. ''The Journal does not necessarily represent the A.M.A.'s position on anything,'' Mr. Johnson said.
The editors found the article disturbing from the start. ''We were blown away,'' Dr. Lundberg said. ''It simply arrived in the mail like any other manuscript. We knew immediately that this was extremely important and worthy of serious deliberation.''
Dr. Lundberg declined to say how long The Journal had the essay before publishing it, but he said that articles usually appear within five or six months after they are received. The essay underwent the standard peer review process, he said, adding,''We considered many medical and legal aspects prior to publishing.''
The Journal agreed to publish the article anonymously, a decision that breaks with scholarly tradition but that is not unheard of at The Journal. The use of anonymous sources ''doesn't happen very often, but it happens,'' Mr. Johnson said. ''The principle is important enough that even if it happened once it's worth defending.''
Dr. Arnold S. Relman, editor of The New England Journal of Medicine, one of the nation's oldest and most prestigious medical journals, said that identifying the author would have been a condition of publishing such a piece. ''We don't publish articles anonymously,'' Dr. Relman said.
Dr. Lundberg, The Journal's editor, acknowledged that the staff did not verify the account before publishing it. He also said he knows the name of the author, but added, ''We consider that privileged information as part of the editor-author relationship.''
''Medical editors traditionally trust authors to provide articles that are true,'' Dr. Lundberg said. ''We do not have the capacity for independent investigation of every research article or essay. In that way, we are sitting ducks for fraud by potential liars.''
Experts on the First Amendment said prosecutors were in the difficult position of pursuing a case without first knowing whether they have the authority to do so.
''There is no clear indication that the doctor is in Illinois or that the crime, if there was one, occurred in Illinois,'' said Jane Kirtley, executive director of the Reporters' Committee for Freedom of the Press. ''Therefore, it is not an interest of Illinois.'' Revival of an Old Debate
As expected, the incident has revived a longstanding debate in the medical community about euthanasia, even as signatures are being gathered in California to put an initiative on the ballot that would make ''mercy killing'' legal under certain circumstances.
While many doctors have condoned for some time the practice of withdrawing life support systems at the request of terminally ill patients, legalizing the direct killing of those patients is deplored by most physicians.
A poll conducted last June by Louis Harris and Associates and made public last month showed that physicians are far more adamant on the issue than the general public.
The poll, which was commissioned by the Harvard Community Health Plan, showed that 66 percent of the doctors considered it wrong for a physician to comply with a patient's wishes to end his life, as against 38 percent of the general public. Two hundred physicians and 1,250 citizens were polled. The margin of sampling error was two percentage points for the general public and four percentage points for the doctors. Some Fears and Arguments
Opponents of mercy killing say the essay only underscores their fears and arguments.
''This is a perfect example of why this kind of conduct should not be legalized,'' said Giles Scofield, legal counsel for Concern for Dying, a patient's rights group based in New York. ''Some would say there is a fine line between the withdrawal of treatment and active euthanasia. This doctor clearly crossed that line.''
Advocates of euthanasia also found the essay troubling.
''We're shocked by the speed and spontaneity with which it happened,'' said Derek Humphry, founder and director of the Hemlock Society, a Los Angeles-based group that promotes voluntary euthanasia. ''People say, 'Let's get this over with,' when the doctor comes in to draw blood. That's not a request for death.''
Some physicians say the essay points up a problem in the training of residents. ''The cold, bitter anger in the essay makes you wonder, 'What are we doing in the socialization of our doctors?' '' said Dr. Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota.
''There was a quick inference, an irresponsible leap and no consultation with anyone else,'' Dr. Caplan said. ''It was horrific, but it ought not cast a pall over a discussion of mercy killing.'' Change in Attitude Feared
Dr. Siegler said he considered the case an anomaly, and called it ''a personal failing that goes beyond the system.'' But he said he feared that the appearance of sanctioning active euthanasia could change the way doctors approach their work.
''If you go to the bedside of a patient and the option of killing the patient exists, as it did in the mind of this resident, doctors will be less inclined to think of alternative medical possibilities,'' Dr. Siegler said. ''It will change the mind and attitude of even the most conscientious doctors. And patients will be afraid that their doctor may be a great believer in death with dignity when all they need is their asthma medicine.''
The Rev. John Paris, a professor of medical ethics at Holy Cross College in Worcester, Mass., said such fears were not wholly unwarranted now, adding, ''I think it happens more often than the public would like to believe.''
Physicians are divided over the plausibility of the story, however. Some say that 20 milligrams of morphine would not be sufficient to kill most adults. Others question a reference to an ''alcohol drip,'' a sedative technique now considered outmoded.
Since the essay appeared, The Journal has been besieged with letters on the subject, most of them criticizing the essay and The Journal for publishing it. A collection of those letters and a series of articles on the subject will appear in the April 8 edition of The Journal, Dr. Lundberg said.
''The essay was published with the purpose of generating responsible debate on a very important topic that transcended any personal motivation,'' he added. ''I believe it was successful in doing so.''Continue reading the main story
Arguments For And Against Euthanasia Essay
1960 Words8 Pages
Euthanasia is the practice of ending an individual's life in order to relieve them from an incurable disease or unbearable suffering. The term euthanasia is derived from the Greek word for "good death" and originally referred to as “intentional killing” ( Patelarou, Vardavas, Fioraki, Alegakis, Dafermou, & Ntzilepi, 2009). Euthanasia is a controversial topic which has raised a great deal of debate globally. Although euthanasia has received great exposure in the professional media, there are some sticky points that lack clarity and need to be addressed. Euthanasia is a divisive topic, and different interpretations of its meaning, depend on whether the person supports it or not. While a few societies have accepted euthanasia, there are…show more content…
The patient voluntarily wanted to end his life because he was suffering from Lou Gehrigs’s disease (Siu, 2008). Since then, the controversy over active euthanasia has remained an ethical dilemma for healthcare providers, patients and their family members in America and the rest of the world. The general public’s belief is that, health-care providers have professional obligations to save the lives of their patients regardless of their health status. The majority of the public feels that, healthcare workers’ involvement in the euthanasia practice is a betrayal of the “do no harm” oath. When a healthcare worker is involved in either active or passive euthanasia, it can be viewed as a disregard to this value. However, the proponents for euthanasia claim that a physician turning down a suffering patient’s request to end their life is also a violation to the “do no harm” oath (Siu, 2008). The right to die falls under patient’s autonomy and the basic question is whether individuals should be allowed to end their lives if they choose to do so (Sanders & Chaloner 2007). Those in the healthcare sector grapple with this notion on a daily bases because they have to practice under the codes of ethics guidelines. Nurses and doctors should be cautious in their practice as they balance the patient’s autonomy and their professional ethics and guidelines. Sanders & Chaloner (2007) pointed out that nurses and doctors know that a patient's autonomy