Opting Out

Jack Kevorkian is leading the movement to allow people to take death in their own hands.

"What we need is a brave doctor and a case which will convince the judiciary that reform is required," said British psychiatrist Colin Brewer at the sixth biennial conference of the World Federation of Right to Die Societies in 1986. We now have that brave doctor, twenty cases of physician–assisted suicide and considerable public tumult.

Dr. Jack Kevorkian should be regarded as a hero. He has taken on the tough issue that many physicians have avoided despite the pleas of anguished patients. We have legitimized advance directives, living wills and durable powers of attorney –– aren't we ready for euthanasia?

Passive euthanasia is the removal of an artificial barrier to death, thus allowing nature to take its course, and is generally accepted as a humane medical practice. Active euthanasia involves affirmative action to induce death before nature can take its course in the terminally ill patient who requests it, and should be viewed as the ultimate act of humanity.

The recent debate on active euthanasia began when Kevorkian assisted in the suicide of three patients who had serious but not imminently fatal diseases. He developed a crude but effective suicide machine that allowed individuals to take their own lives in a painless and efficient fashion. After his first patient died, first–degree murder charges were brought against him but were subsequently dismissed. Kevorkian continued the practice and on November 30 he was jailed. He staged a hunger strike to draw public attention to the issue, and after some time in jail, and promising that further attempts at assisted suicide would not occur, he was released on bail.

The advocates of "get Kevorkian and teach him a lesson" seem ignorant of the history of the U.S. movement to legalize euthanasia, which long predates the good doctor. It began in 1906 when the Ohio legislature referred a bill to its Committee on Medical Jurisprudence, which proposed the legalization of active voluntary euthanasia. The bill was rejected by a vote of 78 to 22. Subsequent attempts to legalize the practice occurred in Nebraska, New York and most recently in the state of Washington, where approximately 223,000 citizens signed a petition calling for an amendment to the state's living will law. Broad support was generated for the idea, but voters defeated Initiative 119 by a margin of 54 percent to 46 percent.

Today most states prohibit assisted suicide; Illinois, Ohio and Michigan call it murder. But even so, prosecution of those who have helped a person to die is unusual. It is not surprising that there is so much variation from state to state, because doctors them-selves do not agree on the morality of active euthanasia.

If you become terminally ill, what can you do? Will you attempt to find a friend or physician who can help spare you the pain of a lingering death? Can physicians serve in their traditional role of healer and still assist suicides? Twelve physicians examined this issue in the New England Journal of Medicine. Ten of them concluded that doctors should be able to provide hopelessly ill patients who believe their condition is intolerable with the knowledge and the means to commit suicide. The group also concluded that it should be lawful, under certain circumstances, for physicians to assist patients in ending their lives.

Dr. Timothy Quill offers a more specific prescriptions. With several colleagues, he has proposed guidelines for physicians who find assisted suicide morally acceptable that include: 1) the patient must, of his or her own initiative, clearly and repeatedly request to die rather than continue suffering; 2) the patient's judgment must not be distorted; 3) the patient must have a condition that is incurable and associated with severe, unrelenting, intolerable suffering; 4) the physician must insure that the patient's suffering and the request are not the result of inadequate comfort care; and 5) consultation with another doctor who is experienced in comfort care should take place.

Dying patients need more than prescriptions for mind–numbing narcotics. They need a personal guide and counselor to assist them on their last journey. Opponents of euthanasia argue that this is just the edge of the slippery slope to widespread abuse. They point to the atrocities of Nazi Germany and to the myriad examples of doctors who have acted unethically in Russia, Chile, South Africa and Japan. The debate has begun, thanks to Dr. Kevorkian. The American public must participate in this debate; after all, it is our lives that are at stake. Jailing the debaters, like Kevorkian, will do nothing to has-ten the resolution of this problem.

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