Harry Warner

When helping people to die is required
medical ethics——what can an unethical
doctor who cures them do?

[Transcriber's Note: This etext was produced from
Worlds of If Science Fiction, December 1956.
Extensive research did not uncover any evidence that
the U.S. copyright on this publication was renewed.]

The receptionist ushered the patient into Dr. Walter Needzak's office. She punched her glasses higher onto the bridge of her nose, patted the bun of hair at the back of her head, and said:

"This is Mr. Stallings, doctor."

Dr. Needzak motioned the patient to a chair. Stallings sat down, slowly but limberly. He still held his hat, and placed it in the precise center of his lap. The receptionist handed a form to Dr. Needzak and returned to the waiting room, after looking once over her shoulder.

"You're only 125, Mr. Stallings?" Dr. Needzak asked. The patient nodded sadly. "Well, you should be hale and hearty for another 50 years, judging by the report on your preliminary exam. Are you sure that it's any use for you to consult me?"

"I wouldn't bother you," Stallings said, age showing only in the high pitch of his voice, "except for the funny feeling in my chest the other day. I had to visit an office on the twelfth story. The elevator wasn't running, so I walked up. Just as an experiment, I went as fast as I could. The way my chest felt got me so interested and excited that I forgot what I wanted at the office, once I was there. So I thought that that was a hopeful enough sign for me to come around and see you."

Dr. Needzak, a young man at 50 and who looked even younger, hoisted the stethoscope amplifier onto his desk, turned it on, and signalled for Stallings to unbutton his shirt. He placed the stethoscope against the bony chest. The bumping of the heart filled the room, drew a wild pattern on the unfolding strip of paper in the visual section of the amplifier, and created magnetic patterns on the tape.

Dr. Needzak listened for two minutes, then thumbed through a reference listing of visual heart patterns. Finally he switched off the amplifier, and said:

"You have no history of heart trouble."

"I'm afraid not."

"Well, I don't want to raise false hopes. The only thing that I can suggest is more physical exertion. Really vigorous exertion, the kind that makes you pant and tremble and get a bit dizzy. Try that every day for a month and come back to see me. There's just a trace of a flutter now, and we might be able to speed up its development."

The old man smiled for the first time, at something that his eyes saw behind the white plaster of the far wall. Finally, Stallings rose to leave. Buttoning himself up, he said: "You'll send the bill?"

Dr. Needzak laughed genially. "I can see that you aren't accustomed to visiting doctors, young man. The better the doctor, the more risky it is to send the bill. My policy is to request full payment before the patient leaves the office, just in case I've given the right sort of advice. In cases where I prescribe medicine, of course, you may pay for the prescription and the consultation fee simultaneously. Before taking the medicine, you understand." Again he laughed.

"I understand. I should have guessed. I work in a bank myself. I hate the work. I'm tired of everything, in fact. But I know how important it is to pay promptly."

The doctor had just filed away Stallings' physical record when the receptionist ushered in an extremely elderly woman. Dr. Needzak smiled broadly, and said:

"Mrs. Watkins! I didn't expect to see you again so soon." He waved in annoyance at the receptionist, who hovered behind the new patient. She left, reluctantly.

Mrs. Watkins groped her way to the chair, wincing when the receptionist slammed the door. The old woman rubbed her bony forehead with a mottled hand that trembled and said:

"I know that I wasn't supposed to come back for another three months. But did you realize that I'll have my 190th birthday before those three months are up? When a person gets to be that old, she looks forward to seeing the doctor more than she used to look forward for Santa to arrive back in the old days."

"No symptoms since your last visit?" Dr. Needzak spoke more loudly than usual in deference to her failing hearing, and turned up the light to aid weak, old eyes.

"None." She spat out the word. "I'm going to change doctors, if this keeps up. I've heard of a couple of doctors who aren't as scrupulous as you are. After living all this time, I think that I could be permitted one little crime, lying to them about a symptom. Then I know that I'd be made happy. What's the use being moral when you're too frail and tottery to enjoy life?"

Dr. Needzak shook his head, disapprovingly. "I don't think you're quite as miserable as you think you are. Don't go to those quack doctors. Suppose you're caught, halfway through a crime? You might linger for decades, half-well, half-sick, from the effects of what they'd give you. Even the quacks won't supply you with strychnine, you know."

"I know. I shouldn't have suggested it. But I get so tired of living."

"Well, I can't see any physical trouble that could have developed enough to warrant a complete exam since your last one. Maybe those arteries will start hardening by the time you have that 190th birthday. Or you could take up chemistry as a hobby. Just think what a fine explosion you might get mixed up in!"

"I thought of that." A couple of tears trickled down the wrinkled cheeks of Mrs. Watkins. "But the thrice-great-grandchildren watch me like a hawk. They don't let me do anything that might hurt me. I suppose I'll just have to wait, and hope, and wait, and pray."

She rose, very suddenly. Then she shook her head disgustedly. "I don't even get dizzy when I do that, like most people my age. Thank you, anyway, doctor." Mrs. Watkins walked out with dignity.

Dr. Needzak noticed that his waiting room was filling rapidly, during the two seconds that Mrs. Watkins opened the door to leave. He fumed inwardly at his patience in dealing at length with cases like the last two, whom he couldn't possibly be sure of helping.

But his ill-humor was replaced by astonishment. The receptionist introduced a woman even younger than he. She was very pale, but Dr. Needzak guessed that that pallor derived from tension, not some rare organic disturbance.

"Are you sure that you haven't made a mistake, Miss Tillett?" He asked the question quietly, trying to catch her eyes. She kept them resolutely on her hands, which were folding and unfolding in her lap.

"I talked with several good friends before coming to you, doctor," the girl said. Her voice was very low. "You had been a good doctor for their grandparents or great-grandparents. They told me that you could help me, if anybody could."

"But your preliminary examination shows nothing whatsoever wrong with you," the doctor said. "It'll be another century before you would normally develop the slightest symptom on which I'd be allowed to work. And people of your age just don't go to doctors. It's only when you're past the century mark, and know that decade after decade stretches out ahead of you, that you start feeling that a doctor might—"

"Please," she interrupted, almost inaudibly. "I don't think that a physician should allow the consideration of a patient's age to enter into his course of action. For personal reasons, I may need a doctor more than the average person six times my age."

"Will you tell me something about yourself? I'm not curious, except as far as knowledge might affect my recommendations."

"I don't care to discuss personal problems. Now, doctor, your assistant who gave the preliminary examination overlooked the reason for my coming to you. Right here," and she carefully touched a spot on the well-tailored dress. "I think that it might be a tumor."

"What good does it do to come to a doctor for that?" Dr. Needzak said. "Tumors are so rare that there's very little chance that it's more than your imagination. And the best physician can't speed up the growth of a tumor, or change it from benign to malign."

"A physician can diagnose," she answered. "If it's malign, I'll be able to have patience. I won't need to break the law." Unexpectedly, grotesquely, she drew one finger across her throat in a cutting gesture, and looked squarely at him for the first time.

Dr. Needzak walked softly to the door that led to the reception room. He drew noiselessly a bolt across the jamb, locking it. Then he pointed to another door, telling the girl: "Go in there and undress. I'll be ready for you in a moment."

He whistled softly under his breath, as he pulled instruments and jars of colored substances from the deepest recesses of a cupboard.

The girl already lay calmly on a metal table in the inner room when Dr. Needzak entered. He staggered a trifle under a precariously balanced pile of equipment in his arms. He explained:

"I should let the receptionist do the hard work like this. But I don't let her snoop around in this private room."

"Will you really need all those things?" the girl asked, uncertainly. "I thought that you just snip out a tiny specimen with a little gadget, to make a diagnosis."

"I could probably get along with just that one gadget," the doctor said. He pulled a mask from a drawer and snapped on the sterilite. "But I'm an old boy scout at heart. Always prepared." Unexpectedly, he plopped the mask squarely over the girl's face. Her cry was almost inaudible, as the thick gauze clamped itself over her mouth, clung tightly beneath the jaw.

Dr. Needzak pinioned her shoulders to the table, while her legs kicked wildly for a few seconds. The anesthetic stopped the kicking within five seconds. He waited for a count of ten, before he wrenched the mask free. Turning up the sterilite to full strength, Dr. Needzak began to line up surgical instruments in a neat row, humming under his breath.

Fifteen minutes later, the physician made a pair of injections into the girl's upper arm. Then he swished oxygen into her face until she recovered consciousness.

"Wonderful stuff, this new anesthetic," he told her placidly. "It works fast, wears off just as fast, doesn't leave the patient retching. Now, you can sit up slowly. If you don't try anything strenuous for the next day or two, you'll never know that you've had an operation."

Miss Tillett's eyes widened. "Operation! I came here for a diagnosis. I didn't authorize—"

"I'm sorry. I operated without your consent. But I had a good reason. It wasn't even a benign tumor that you had. It was only a cyst. If I had merely diagnosed, and told you the truth, you would have kept clinging to the hope that it might be a malign tumor. You wouldn't have let me take it out. It would have grown big enough to disfigure you, not big enough to cause you any physical damage. You would have gone through the years with a new trouble, that of deformity, and you might have been mentally warped in the delusion that you had a fatal disease. You're as sound as a rock."

Something inside the girl seemed to turn into liquid. She sat with slumped shoulders, arms dangling limply at her side, and head sunk so far that her chin rested against her chest.

After a moment, she rose and walked slowly into the dressing cubicle. When she emerged, she ignored the doctor, unlocked the door with her own hands, and walked into the reception room, sobbing softly.

Dr. Needzak cleaned up rapidly, and hustled into his main office to see his next patient. No one was there. He grumbled to himself and opened the door into the reception room. Blinking, he saw that it was empty. It had been filling rapidly, not a half-hour earlier.

The doctor had heard no noises indicating a commotion on the street outside; and that was the only reason he could think of for the sudden disappearance of his patients. To make sure, he strode through the reception room, walked briskly down the short hall, and stuck his head through the door leading into the street. Everything appeared normal in the bustling business district, until a large, black sedan ground to a stop at the curb in a no-parking zone. The receptionist climbed from the vehicle, two men behind her.

"Miss Waters!" Dr. Needzak exploded, when she reached the building's entrance. "What do you mean by leaving without my permission? All my patients have left. They must have thought that office hours were over."

The receptionist gave him one baleful look, and shoved past him into the building. And Dr. Needzak suddenly recognized the two men.

"Bill Carson! And Pop Manville! What brings you big doctors down here to see a small-time pill-dealer like me?"

"Let's go into your office," Pop said, softly. He was old, tall and gaunt with a perpetual look of worry. Dr. Carson, younger and bustling, evaded Dr. Needzak's eyes.

Miss Waters was shoveling personal belongings from her desk into a giant handbag, when they reached the reception room. Dr. Needzak felt her eyes upon him, as the other two physicians kept him moving by the sheer impetus of their bodies into his consultation room.

"Where is it, Walt?" Dr. Manville asked, looking gloomily around the consultation room.

"Where's what, Pop? The drinks? I keep them—"

"The door to your operating room," Dr. Carson interrupted, hurriedly. "Let's not drag this thing out. It's going to be painful enough, among old friends. Your private office has been wired for sight and sound for the past three weeks. You shouldn't have tried to get away with that kind of practice in a big city."

Dr. Needzak felt the blood draining from his face. He reached for a drawer. Dr. Manville grabbed his arm with a tight, claw-like grasp, before it could touch the handle.

"It's all right, Pop," he said. "Nothing but gin in there. I'm not the violent type."

Dr. Carson pulled open the drawer toward which he had reached. He pulled out the tall bottle, slipped off the patent top, and sniffled. Handing it to Dr. Needzak, he said:

"Okay. You need some. Then save the rest for us. We'll feel like it, too, when we're done."

Dr. Needzak coughed after three large swallows. He looked at the other two doctors. "Who ratted?"

Dr. Carson nodded toward the reception room. Dr. Needzak instinctively clenched his fists. He half-rose from his chair, then sank back slowly. "I thought you guys were my friends," he said.

"We are, Walt," Dr. Manville said thoughtfully. "But this is business. When someone charges violation of medical ethics, we're the investigation committee. It looks like a simple investigation this time, with those tapes on file."

"What does she have against you, anyway?" Dr. Carson asked. "Usually a receptionist will go through hell to cover up little flubs for her boss. Were you mixed up with her in a personal way?"

"Mixed up with her?" Dr. Needzak laughed mirthlessly. "She's worked for me fifteen years. I've never made a pass at her."

Dr. Manville nodded sadly. "That was your mistake, Walt. Frustration. Disappointment. Worse than jealousy. Now, why not tell us everything?"

"There's nothing to tell. Those tapes give a false impression, sometimes. I just take difficult cases back there where I'm sure there won't be any disturbance."

"No use," Dr. Carson interrupted. "Things will be harder for you, if we lose patience with you. We know you've been curing illness against the patient's wishes, time after time. We just saw you take out a tumor. The poor kid will probably drag through another hundred years before she develops anything else serious. You prescribed anticoagulants to a man with an obvious blood clot. You even talked a couple with weak lungs into moving to Denver."

"All right, it was a tumor," Dr. Needzak admitted. "It was malign and it would have killed her in two or three years. But she's too young to make a decision for herself. Five years from now, she may have a different outlook on her personal problems. I have ethics, and I can't help it if they don't correspond in some details with the association's ethics."

"You were given your medical license under an oath to respect the ethics of the profession," Dr. Manville said slowly, emphatically. "The license did not give you the right to practice under ethics of your own invention."

"Ethics!" Dr. Needzak looked as if he wanted to spit. "Ethics is just a word. There was a time when physicians spent their time curing diseases and preventing them. They called that ethics. Now that there aren't enough illnesses left to give us work, now that people live long past the time when they want to go on living, now that we make our money helping people commit suicide the legal way, we call that ethics."

"You can't annihilate a concept simply by thinking it's only a word," Dr. Manville said. "There was a time when physicians used leeches for almost every patient. They fitted that nasty habit into their ethics. You wouldn't want to introduce leeches into this century, would you? But you should, if you're so consistently opposed to anything that sounds like changes in ethics."

"But I've done my part to get rid of human miseries," Dr. Needzak said, nodding toward a filing cabinet. "I can show you the data on hundreds of my patients. Old folks, who just got tired of living; I helped them die legally. Even younger people, who had a genuine reason for being tired of life. I couldn't have my fine home or pay rent in this building, if I went around curing every patient. There's no money in that."

"You wouldn't keep a filing cabinet for the times you disobeyed the medical code," Dr. Carson broke in. "But we have some of those cases on tape. You didn't refuse to handle the cases. You went ahead and played God, going directly against the direct will of your patients. Did you follow up all of the patients who aren't in your file cabinets? We traced the later records of some of them. Several suicided right out in the open. Their families haven't gotten back on their feet from the disgrace yet."

Dr. Needzak took two more deep swallows from the bottle. He looked glumly at the low level of the liquid through its dark side, saying:

"You fellows are enjoying this conversation more than old friends should enjoy the job of taking action against a fellow-doctor. And I'll tell you why you aren't too unhappy about it. You're jealous of me. You're jealous of the fact that I've been following a physician's natural instincts and healing people. You're angry with me for doing the things that you'd really love to do yourselves, if you had the guts. You aren't worried about that girl; you're peeved because you'd give your shirts for a chance to take out a genuine tumor yourself."

"Admitted," Dr. Carson said cheerfully. "I haven't seen a live tumor in three or four years. They're scarce. But we can't sit here chatting. We don't want to end up arguing."

Dr. Needzak rose. "What do I do, then?"

"The best action would be to come along with us to the association headquarters," Dr. Manville advised, avoiding Dr. Needzak's eyes. "In a half-hour or so, you can sign enough statements to avoid weeks of hearings. Otherwise, we'll be forced to bother lots of other physicians, hunt up your old patients, endure newspaper publicity, and have a general mess."

"After that, I start pounding the pavements, hunting a job." Dr. Needzak flexed his long, lean fingers. "Is it hard to learn how to operate ditch diggers?"

Dr. Carson stood up and slapped him on the back. "It isn't that bad. You can find a place in any pharmacy in the country, if we get through this disbarment without publicity. You'll never be rich, handing out irritants and hyper-stimulants, but—"

Dr. Needzak was already striding toward the street. The other two doctors trailed after him, waiting while he locked up carefully. They glanced at one another significantly, noting that he had unconsciously brought along his little black bag. Dr. Needzak explained as they began the two-block walk to association headquarters:

"The kids are married and away from home. I suppose that I can get enough income from sub-leasing the office to keep the wife and me eating until I find—"

A grating crash broke into his sentence. The three doctors whirled simultaneously. Thin wails drifted through the constant rumble of traffic, from somewhere around a corner. People erupted from buildings, running toward the source of the noise. The doctors instinctively trotted after them.

They turned the corner, coming upon a rare sight. It was a motor vehicle accident, first in the business district for months. A school bus lay on its side, just short of the intersection. Children were clambering cautiously from the emergency door. The uniformed driver was ignoring his passengers, staring in disbelief at the radar controls at the street corner, which had failed a moment earlier.

The other vehicle involved in the crash was wrapped around a power pole. It was an auto of antique vintage, produced before full automatic driving provisions. There weren't more than a dozen such vehicles remaining on the streets of the city. The radar controls almost never went on the blink. Only the combination of the vehicle and the inoperative controls could have created an accident.

Dr. Needzak led the other doctors through the thickening crowd, to the side of the bus. Kids were no longer climbing through the emergency exit, but noises were coming from within the vehicle. His bag under his left arm, he hauled himself atop the overturned bus, and dropped through the emergency exit into its half-dark interior. He saw the other two doctors outlined against the sky, as they perched on the horizontal side of the vehicle, peering down, helpless without their bags.

Dr. Needzak found a small boy sprawled awkwardly around a seat, bleeding rapidly from the leg, face ashen, unconscious. The physician clipped off the trousers leg, bound the leg tightly above the deep gash, and slipped on a bandage. Then he lifted the small boy up to Dr. Carson.