New mercy-killing heat

Four of the nation's top physician-ethicists today condemned theJournal of the American Medical Association for its handling of adoctor's unsigned first-person account of a mercy killing, terming itirresponsible.

The essay, titled "It's Over, Debbie," netted the journal morethan 150 letters, which editor George D. Lundberg described as a"hefty" response. The letters led him to conclude that the publicappears to favor mercy killing more than physicians do.

Dr. Willard Gaylin of the Hastings Center in New York and threeother prominent ethicists called on the AMA's Council on Ethical andJudicial Affairs to examine the essay and the decision to publish it."Justice requires nothing less," they said.

"The conduct of the physician (in the essay) is inexcusable,"Gaylin wrote in a commentary. "But the conduct of the editor of JAMAis incomprehensible. By publishing this report, he knowinglypublicizes a felony and shields the felon.

"He deliberately publicizes the grossest medical malfeasance andshields the malefactor . . . presumably allowing him to continue hispractices without possibility of rebuke and remonstrance, not evenfrom the physician whose private patient he privately dispatched.Why? For what possible purpose central to JAMA's professionalmission?"

The commentary was co-signed by Dr. Leon Kass of the Universityof Chicago; Dr. Mark Siegler, director of the U. of C.'s Center forClinical Medical Ethics, and Dr. Edmund Pellegrino of the KennedyInstitute of Ethics, Washington, D.C., who serves on JAMA's advisoryboard.

An AMA spokesman said the ethics council, which sets ethicalpolicies for the AMA, does not plan at present to examine the case.And the AMA's board, which serves as JAMA's publisher, already hasgiven Lundberg a vote a confidence.

Lundberg ran the essay Jan. 8 to stir a debate onphysician-assisted euthanasia. In the essay, an exhausted gynecologyresident describes how he gave a fatal injection to a suffering20-year-old cancer patient. Doctor and patient had virtually nodiscussion.

Cook County State's Attorney Richard M. Daley unsuccessfullyattempted to obtain the name of the author from the Chicago-based AMAto investigate a possible murder. A subpoena obtained by Daley wasquashed.

Lundberg defended publication of the essay in an editorial,saying a public debate on euthanasia was vital since the issue ofphysician-assisted euthanasia probably will be voted on inCalifornia.

"I believed it was time for the euthanasia debate to be held onthe pages of a peer-reviewed medical journal," he wrote. "Suchdiscussions should not be confined to whispers in doctors' dressingrooms. . . . "

Lundberg said he was disturbed that some critics interpretedpublication of the essay as AMA and JAMA support for euthanasia. Hestressed that he and the AMA oppose such illegal and unethical acts.

Lundberg published two commentaries and 18 letters in today'sissue and concluded: "If physicians' letters are any indication,mainstream physician involvement in active euthanasia is unlikely inthe near future in this country. On the other hand, the responsefrom the public suggests that many of our patients would want activeeuthanasia if needed, and they would want it performed by doctors."