It's Over, Debbie

To the Editor. —I was distressed by the article in the Jan 8,1988, issue ofJAMAentitled "It's Over, Debbie."1I, too, was a tired gynecologic resident rotating through large hospitals and I saw similar situations and, perhaps, responded no better than our nameless physician. After that, I did three years of internal medicine training that did not help me prepare for managing such difficult problems. I went to the United Kingdom to study how things are done at the University of Edinburgh and at St Christopher's Hospice in London and then became medical director of a hospice. During the past five years I have treated some 2000 terminally ill patients to the times of their deaths, mostly in their own homes but sometimes in our inpatient facility. I have learned that patients like Debbie do not need to be killed by their physicians to be relieved of their