One of the most famous lines in all of medical ethics literature is “It’s all over now, Debbie.”

Those words were written and published in the New England Journal of Medicine in the 1970s. It was an anonymous first-person account by an intern who was caring for a woman dying of metastatic cancer.

She was in horrible unrelenting pain. One night in her despair, she cried out to him in agony, “Please help me, I can’t do this anymore.”

The pain relief was not working. She had no more than a few days or weeks to live. The intern responded out of deep frustration and compassion, and brought a terminal dose of narcotics into the room and spoke those words to her.

While not explicitly saying so, it was clear from the essay that he helped end her life on her terms. As expected, it created a firestorm in medical, legal and ethical worlds.

Participating in what is now called physician-assisted suicide was illegal nationwide, as it still is in many states.

Many prosecutors promised to bring charges of homicide against the physician if they could discover his identity. The publication did not reveal his identity.

This was before the Kevorkian era and a handful of pioneering states and ethicists began to present euthanasia and physician-assisted suicide as reasonable choices that people of faith and strong morality could openly discuss.

Death with dignity

Death with dignity was not a concept that many spoke of in public. If it were discussed, the subject was never intended to leave the door open for health care professionals to expedite a patient’s demise.

But this discussion needs to be placed in context of other forms of euthanasia. This is an example of what is now called active, voluntary euthanasia.

With full informed consent and in hopelessly terminal cases, the patient simply requests help in dying. It is an active, free choice.

We need to remember that we practice other forms of euthanasia. Active involuntary euthanasia is simply the enactment of capital punishment supported by a majority of Americans.

Passive euthanasia is withholding treatment for terminally ill patients either at their request or the family’s. It is letting nature take its course.

It is done when respirators are disconnected for a brain-dead patient and when decisions are made to not administer intravenous fluids or antibiotics to prolong life a few extra days.

Most Americans now have advanced medical directives that guides the health care professionals through this ethical quagmire through end-of-life decisions.

So euthanasia is a part of every hospital in the country. Yet there is something morally profound and disturbing for many about helping a person end life, even when the patient’s days are limited.

It gets at the heart of what civilization stands for. It tugs not only at our emotional heartstrings, but also our sense of ethical and religious norms and values.

But I believe it is an act that can indeed be done out of profound love, and respect for human life and dignity. It is an act that is consistent with my own religious tradition and faith.

Questions we should always ask ourselves in the medical profession as well as our common culture is what is our highest value? What is our goal?

Upon what religious traditions do we fall back on to answer what are very personal and profound questions?

I would submit that the worship of biological life can take on a form of idolatry, substituting human existence for something more intimate and divine.

Providing an extra amount of time for a person that results in agonizing suffering seems almost inhumane and narcissistic of us as healers.

We often treat our pets with more dignity and compassion. Insistence of prolonging life at all costs seems to place our own needs and beliefs above that of our patients. I believe that a goal which many religious traditions share is relief of suffering based on compassionate love.

Preservation of life at the expense of dignity and freedom is often a misguided attempt to deny our patients something they all want — the freedom to choose their own terms of their passing from this world.

Michael Attas is a local doctor, a medical humanities professor and an Episcopal priest. Contact him at Michael_Attas@baylor.edu.