A midwife through the dying process: stories of healing and hard choices at the end of life

In Timothy Quill's recounting of the deaths of nine patients, the final description is of the planned death of Jules: at home, surrounded by family members, and aided by a physician. It is a moving, true story, recounted in meticulous detail, from the first diagnosis to the final dose of barbiturates. But despite its many similarities, this is not the famous case of Diane, described by Dr. Quill in the Journal some six years ago in an account that launched much of the current discussion about physician-assisted suicide ("Death and Dignity: a Case of Individualized Decision Making." 1991;324:691-4). Jules's planned death involves the removal of a respirator on which amyotrophic lateral sclerosis has made him dependent. In this case, a planned death in the presence of the family and with the cooperation of the physician is possible because the patient happens to be dependent on a life-sustaining therapy that he can choose to discontinue - and thus deliberately and legally bring about his death.