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Timothy E. Quill, MD

JAMA. 1993;270(7):870-873.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

IT HAD been 18 months since a 67-year-old retired man whose main joy in life was his two grandchildren was diagnosed with inoperable lung cancer. An arduous course of chemotherapy helped him experience a relatively good year where he was able to remain independent, babysitting regularly for his grandchildren.

Recent tests revealed multiple new bony metastases. An additional round of chemotherapy and radiation provided little relief. By summer, pain and fatigue became unrelenting. He was no longer able to tolerate, much less care for, his grandchildren. His wife of 45 years devoted herself to his care and support. Nonetheless, his days felt empty and his nights were dominated by despair about the future. Though he was treated with modern pain control methods, his severe bone pain required daily choices between pain and sedation. Death was becoming less frightening than life itself.

See also pp 874 and 875.

A particularly severe . . . [Full Text PDF of this Article]

Author Affiliations
From the Program for Biopsychosocial Studies, School of Medicine, University of Rochester, and the Department of Medicine, The Genesee Hospital, Rochester, NY.

Footnotes
The views expressed in this article are those of the author and do not necessarily represent those of the University of Rochester or the Department of Medicine.

Reprint requests to the Department of Medicine, The Genesee Hospital, Rochester, NY 14607 (Dr Quill).

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