Courageous or careless? Medical journal editor invites controversy with mercy killing story; other editors comment

Folio: The Magazine for Magazine Management, May, 1988 by Diane Cyr

Courageous or careless?

"I took the syringe into the room and told the two women I was going to give Debbie something that would let her rest and to say good-by. Debbie looked at the syringe, then laid her head on the pillow with her eyes open, watching what was left of the world. I injected the morphine intravenously and watched to see if my calculations on its effects would be correct."

So related an unidentified physician in one of the most controversial magazine articles published this year. "It's over, Debbie," which appeared in the Journal of the American Medical Association (JAMA), gave a striking first-person account of a gynecology resident who, responding to a routine call, administered a fatal dose of morphine to another doctor's patient--a young woman suffering from cancer. The woman, emaciated, distressed and fighting for breath, had said simply, "Let's get this over with."

The New York Times, The Washington Post and other top papers reprinted the piece and scrutinized public reaction. Public television's "MacNeil/Lehrer Newshour" interviewed JAMA editor Dr. George Lundberg. Everywhere, there were questions: Why would JAMA publish, without editorial comment, a first-person account of a medical crime? Why did JAMA protect the author when issued a grand jury subpoena? (The subpoena was later quashed.) And why didn't JAMA investigate whether the article was fact or fiction?

To some readers, it seemed that JAMA was endorsing mercy killing--a charge Lundberg calls "absurd." He explains that the piece appeared in a department called "A Piece of My Mind," a section reserved for readers' opinions, philosophies and fantasies. In addition, he says, although the peer-reviewed Journal accepted the story as true, the article's purpose was to educate doctors, not to document a crime.

"I'm a pathologist, and as such have used the case study method of teaching," Lundberg told FOLIO:. "Cases are used as a starting point for the purposes of education, and in this method it doesn't make any difference if the case is true, false, or in-between."

With this unsolicited story, he says, "we knew we were getting into extreme controversy. But we felt it was time for the profession and public to seriously confront the profound issues."

Not all editors agree. Top editors and publishers recently interviewed by FOLIO: gave a variety of responses to the question: What would you have done if you received such a manuscript for publication? Cullen Murphy, managing editor The Atlantic

One thing is certain: We wouldn't have run the piece without knowing if it was fictional or factual. Once we determined it was fiction, we would judge it as one would any piece of fiction: What statement is it making about the human condition, and so on.

If factual, then you're dealing with a person who committed a crime, whether one agrees whether it should be a crime or not. So that opens several cans of worms. If you know who the writer is, then choose not to run the name, then you are probably withholding information from pertinent authorities. You may decide that's a risk you're willing to take.

But, just speaking personally, I would question what the value is of a piece like that. What is the reader learning that is new? Can anyone not imagine what a doctor must go through in making this decision? Anybody who is thoughtful can come up with all the arguments, pro and con, in about 10 seconds. It's a subject that's been percolating for two decades or more. The only reason to run such a piece is to make a splash. And the more such pieces are splashed on front pages, then the more heat and the less light you're going to get. Lee Eisenberg, Editor Esquire

We would have published the piece. I think it was an important, and dramatic, and journalistically powerful expression of an important contemporary issue. We would have published it anonymously, reluctantly, and we would have definitely protected the source.

I think with a piece like that, which is so incendiary and inflammatory, we would have stated our position on all those matters in an accompanying editorial statement, as a way of consciously anticipating the outcry. We would have also subjected it to a thorough fact verification--not just to ensure that it's nonfiction, but that all assertions are true. That would all be done under the strictest confidence.

Wherever possible [protecting the source] is to be avoided. But in a case like this, it's clear we would have to protect the author. Until the law is otherwise, he has the right to be protected. George A. Glenn, vice president, editorial Edgell Communications, Inc.

JAMA should have verified the authenticity. I would have done that. This is a delicate enough case where a good editor would want to find out whether this is a real life story. If the story is factual, and if the person did sign the piece, the editors owe it to themselves and the author to find out how far he intended to carry this. Was this an open confession on his part? What were his intentions in submitting it? I would tape-record any statements. The natural reader reaction would be, who wrote this? Someone has got to answer that question, and that better be planned out.