The influence of medical and legal authorities on deaths facilitated by physicians.

This study investigated whether two widely publicized cases of deaths facilitated by physicians were followed by significant peaks in mortality. In March, 1991, Timothy Quill, MD, published a controversial editorial describing the physician-assisted suicide (PAS) of his 45-year-old, female leukemia patient. In a landmark decision in December 1990, the Missouri Supreme Court allowed removal of life support for Nancy Cruzan, a comatose accident victim. Correcting for trends and seasonal fluctuations, the authors examined: (1) U.S. leukemia mortality in the period centered on Quill's editorial, and (2) mortality from accident/coma combinations in the period centered on the Missouri Supreme Court's decision on Cruzan. Female leukemia deaths rose 11.3% above the expected rate (p < .01) just after Quill's article was published. The more closely the decedent matched Quill's patient, the greater the peak, with the largest peak (33.9%) evident for female leukemia patients in their 40s, who were long-term residents of smaller communities (p < .05). Five possible explanations for the findings were assessed, leading to the conclusion that Quill's editorial elicited an increase in mortality. The involvement of physicians in this increase is supported by analysis of the Cruzan case. This showed a mortality peak of 57% for accident/coma patients following the court decision.