DEATH AND DIGNITY

A persuasive argument for giving the severely ill, and those facing a lingering death, options about levels of care, as well as the right to a dignified death. Former hospice-director Quill (Medicine and Psychiatry/University of Rochester) made headlines in 1991 with an article in the New England Journal of Medicine (reprinted here) describing how he assisted a terminally ill woman to commit suicide. Stories of other patients' dire experiences reinforce Quill's contention that medicine's traditional focus on fighting death to the end must be balanced by a humane philosophy of ``comfort care'' that concentrates on relieving suffering and improving the quality of life—even at the risk of shortening it. Comfort care, the author says, offers the terminally ill the chance to live their remaining time with less pain and more peace of mind, as well as the possibility of dying with more dignity, control, and support. Quill argues that the question of physician-assisted suicide should be examined anew, and he proposes some clinical guidelines to stimulate discussion. Unlike Derek Humphry (Final Exit, 1992) or Jack Kevorkian (Prescription: Medicine, 1991), Quill operates in the mainstream, urging cautious exploration and carefully considered changes in public policy. Meanwhile, he urges readers to prepare advance directives to guide their own medical treatment in the event of loss of mental capacity, and he includes samples of a living will and a health-care proxy statement, along with instructions on their use. In a final chapter, Quill sets specific tasks for potential patients (meaning all of us), physicians, institutions, and policy-makers concerned with modifying society's response to the life-and-death issues he has raised. A thoughtful, well-documented addition to the often high- pitched debates on this emotional subject.