Kevorkian's murder charge: Is assisted suicide ethical?
By: Rusty Wright
Dr. Jack Kevorkian recently administered lethal drugs to a Michigan man and aired a videotape of the event on CBS-TV's "60 Minutes". The patient, Thomas Youk, suffered from Lou Gehrig's Disease (ALS) and said he wanted to die. Oakland County prosecutor David Gorcyca charged Kevorkian with first-degree murder, claiming "consent is not a defense to homicide" in Michigan.
Is it ethical for a physician to assist a suffering patient's suicide or to actively euthanize a patient, as Kevorkian claims to have done in this case? End-of-life (EOL) decisions are rarely easy. Comfort, dignity, autonomy and money are chief concerns. Some feel patients in unbearable pain deserve freedom. A Hemlock Society slogan affirmed, "Death is not the enemy; suffering is."
Many elderly fear being hooked up to elaborate machines with tubes and wires, unable to control bodily functions or their own destinies. EOL costs can burden families.
Despite these concerns, the American Medical Association has called physician-assisted suicide (PAS) "fundamentally incompatible with the physician's role as a healer...difficult or impossible to control...(inherent with) serious societal risks."
Many physicians (half, in one Oregon study) admit they are unable to predict when a patient is terminal (i.e., has six months or less to live).
Many PAS-requesters are depressed. News reports suggest depression in Youk. Depression often goes undiagnosed and untreated, yet often when it is treated suicide wishes subside.
Georgetown University ethicist Edmund Pellegrino M.D. claims proper pain management can dissuade patients from choosing euthanasia. Common estimates are that greater (some say much greater) than 95 percent of EOL pain can be successfully managed.
Duke psychiatrist Harold Koenig discovered that those most likely to be affected by PAS - the frail elderly - opposed it the most. Only 39.9 percent of elderly patients favored assisted suicide; 59.3 percent of their relatives did, a finding likely to make many patients gulp.
Many PAS opponents fear legalization will begin a tragic slide toward euthanasia since, for example, Nazi concessions to euthanasia opened psychological and moral doors to extermination.
In Holland PAS, though illegal, has been practiced for years but with some disturbing results. One doctor euthanized a dying woman because "(i)t could have taken a week before she died. I needed the bed." In a famous study 23 percent of Dutch physicians admitted to euthanizing without explicit patient request; another 32 percent said they might.
Kevorkian's critics say he has violated his own guidelines by minimizing counseling, palliation (comfort care) and medical review. Some disabled-rights activists oppose PAS for fear they may be next.
PAS runs counter to several time-honored ethical traditions. Speaking at Duke University commencement, ABC-TV news anchor Ted Koppel affirmed, "What Moses brought down from Mount Sinai were not the Ten Suggestions; they are Commandments....they codify...acceptable human behavior, not just for then or now, but for all time." "Do not murder" is, of course, the Sixth Commandment.
The Hippocratic Oath states, "I will not give poison to anyone though asked to do so, nor will I suggest such a plan." Anthropologist Margaret Mead, certainly no religious zealot, hailed the Hippocratic tradition as "a priceless possession which we cannot afford to tarnish."
The hospice movement seeks to create conditions which make PAS unnecessary by resolving concerns over comfort, dignity, autonomy and money. Hospice provides health and social care to help one die alert, relatively pain free, naturally and in familiar surroundings rather than connected to expensive machines that prolong dying.
New York physician, geriatrics professor and palliative care specialist Dr. Diane Meier was a longtime influential PAS supporter. In a 1998 New York Times column she explained her recent reversal. She now feels that dying patients - often confused and depressed - are rarely able to make the necessary judgement. She admits that six-month terminability is nearly impossible to establish and concludes it is impossible for a doctor to certify that coercion has not occurred since, given great EOL financial pressures, the availability of PAS is itself coercive.
Filmmaker Woody Allen quipped, "I don't mind dying: I just don't want to be there when it happens." Yet it's a certainty we all must face. PAS and active euthanasia raise more problems than they solve.
"Real Answers" furnished courtesy of The Amy Foundation Internet Syndicate. To contact the author or The Amy Foundation, write or E-mail to: P. O. Box 16091, Lansing, MI 48901-6091; firstname.lastname@example.org. Visit our website at www.amyfound.org.
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