Dr. Kevorkian's Victims

http://www.nytimes.com/2011/06/06/opinion/06douthat.html

June 5, 2011
By ROSS DOUTHAT

The case for assisted suicide seems to depend on human sympathy — on the impulse toward mercy, the desire to ease what seems like pointless pain and suffering. Why shouldn’t the terminally ill meet death on their own terms, rather than at the end of prolonged agonies? Why shouldn’t the dying depart this earth with dignity, instead of enduring the inexorable stripping away of their physical and mental faculties?

Such are the sentiments that made Jack Kevorkian, who died last week of natural causes, a hero to many millions of Americans. Though he was tried repeatedly and finally convicted of second-degree murder, the former pathologist’s career as “Dr. Death” (he said he assisted at more than 130 suicides) was widely regarded as a form of humanitarianism rather than a criminal enterprise.

But if such sentiments are understandable, they are morally perilous as well. We do not generally praise doctors who help dispatch their terminally ill patients, as Kevorkian repeatedly and unashamedly did. Even when death is inevitable and inevitably painful, it is not considered merciful to prescribe an overdose to a cancer victim against her will, or to gently smother a sleeping Alzheimer’s patient.

The difference, of course, is that Kevorkian’s clients asked for it. That free choice is what separates assisted suicide from murder, his defenders would insist.

But this means that the moral case for assisted suicide depends much more on our respect for people’s own desire to die than on our sympathy for their devastating medical conditions. If participating in a suicide is legally and ethically acceptable, in other words, it can’t just be because cancer is brutal and dementia is dehumanizing. It can only be because there’s a right to suicide.

And once we allow that such a right exists, the arguments for confining it to the dying seem arbitrary at best. We are all dying, day by day: do the terminally ill really occupy a completely different moral category from the rest? A cancer patient’s suffering isn’t necessarily more unbearable than the more indefinite agony of someone living with multiple sclerosis or quadriplegia or manic depression. And not every unbearable agony is medical: if a man losing a battle with Parkinson’s disease can claim the relief of physician-assisted suicide, then why not a devastated widower, or a parent who has lost her only child?

This isn’t a hypothetical slippery slope. Jack Kevorkian spent his career putting this dark, expansive logic into practice. He didn’t just provide death to the dying; he helped anyone whose suffering seemed sufficient to warrant his deadly assistance. When The Detroit Free Press investigated his “practice” in 1997, it found that 60 percent of those he assisted weren’t actually terminally ill. In several cases, autopsies revealed “no anatomical evidence of disease.”

This record was ignored or glossed over by his admirers. (So were the roots of his interest in euthanasia: Kevorkian was obsessed with human experimentation, and pined for a day when both assisted suicides and executions could be accompanied by vivisection.) After his release from prison in 2007, he was treated like a civil rights revolutionary rather than a killer — with fawning interviews on “60 Minutes,” $50,000 speaking engagements, and a hagiographic HBO biopic starring Al Pacino.

Fortunately, the revolution Kevorkian envisioned hasn’t yet succeeded. Despite decades of agitation, only three states allow some form of physician-assisted suicide. The Supreme Court, in a unanimous 1997 decision, declined to invent a constitutional right to die. There is no American equivalent of the kind of suicide clinics that have sprung up in Switzerland, providing painless poisons to a steady flow of people from around the globe.

Writing in The Atlantic three years ago, Bruce Falconer profiled one such clinic: Dignitas, founded by a former journalist named Ludwig Minelli, which charges around $6,000 for its ministrations. Like Kevorkian, Minelli sees himself as a crusader for what he calls “the last human right.” And like Kevorkian, he sees no reason why this right — “a marvelous possibility given to a human being,” as he describes it — should be confined to the dying. (A study in The Journal of Medical Ethics suggested that 21 percent of the people whom Dignitas helps to commit suicide are not terminally ill.)

But unlike Kevorkian, Minelli has been free to help kill the suicidal without fear of prosecution. In the last 15 years, more than 1,000 people have made their final exit under his supervision, eased into eternity by a glass of sodium pentobarbital.

Were Minelli operating in the United States, he might well have as many apologists and admirers as the late Dr. Death. But it should make us proud of our country that he would likely find himself in prison, where murderers belong. 

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http://douthat.blogs.nytimes.com/2011/06/06/suicide-and-abortion/

Suicide and Abortion

June 6, 2011, 2:48 pm

From Will Saletan’s piece on the death of Jack Kevorkian (whose career is the subject of my column today):

    My father, like Kevorkian, never had to kill himself. But I saw the morphine and the pills. I learned to calibrate and fill the syringe. I sat with him as the hospice nurses quizzed him about pain and breathing. I saw the dosage go up or down with his labor and anxiety. They promised to protect him from suffering. We all knew what that meant. And this is what happens every day, not in a rusty van, but in loving homes around the world.

    That’s where these decisions belong. And that’s how they should be made. Assisted suicide, it turns out, is a lot like abortion. No government can stop it—I would have risked jail to get the pills if necessary—and efforts to enforce its prohibition only make it less careful and humane. But, like the right to abortion, it can be abused. People want to die for all sorts of reasons. Sometimes it’s agony. Sometimes it’s boredom. Sometimes it’s fear. Maybe your mother needs a lethal prescription. Maybe she needs antidepressants. Maybe you just need to hold her hand.

In a sense, Saletan’s account of his own father’s passing suggests a sense in which abortion is very unlike assisted suicide. It can be hard to tell exactly what counts as assisted suicide and what doesn’t, because there are obvious moral gray areas with end-of-life care — places where the line between easing pain and easing passing gets blurry, places where it’s unclear where reducing suffering ends and abetting suicide begins. Whereas with rare exceptions (certain versions of the morning-after pill, perhaps), abortion is much more of an either-or: You either kill the fetus/embryo or you don’t, and there’s rarely any doubt about what just happened.

But there’s some truth to Saletan’s analogy nonetheless. I just don’t think that it quite takes us where he thinks it does. He doesn’t want to live in a police state where hospice nurses are arrested for dispensing morphine too freely, and neither do I. But it’s possible to accept that no government can “stop” assisted suicide or abortion completely (and that no government should create the kind of deeply- invasive mechanisms required to try) without believing that either practice should therefore be legalized and legitimated. Avoiding the police-state scenario doesn’t require treating self-slaughter as a protected right, and effectively licensing the Jack Kevorkians of the world to cater to anyone who wants to die badly enough to take the plunge. That’s how our laws treat abortion, and the result is a kind of abortion industry — in which the country’s largest abortion provider doubles as a major Democratic interest group, and for-profit freelancers take advantage of the vulnerable (a subject that Saletan has written about eloquently). If the right to die really became “a lot like” the right to abortion in America, there would be Swiss-style thanatoriums in most American cities, the Hemlock Society would be a major lobbying group (boasting, no doubt, that most of its resources go to palliative care rather than assisted suicide), and Kermit Gosnell-style thanatists would prey on the elderly while the courts looked the other way.

That scenario seems unlikely, mercifully. For one thing, the demand for suicide is lower than the demand for abortion (though treating the act as a protected liberty would probably expand that demand). For another, even the states that have legalized assisted suicide have kept the practice much more tightly regulated than post-Roe v. Wade abortion. But with that in mind, here’s a counter-scenario for Saletan: If we treated abortion the way, say, Oregon treats assisted suicide, it would only be legally sanctioned in rare cases — involving, say, severe fetal deformity or a threat to the life of the mother — and even then it would have to be approved by two physicians and hedged around by waiting periods. That kind of regime would represent an enormous victory for pro-lifers, and it’s obviously not something that Saletan would support. But it’s arguably where his analogy points, if it points anywhere at all.


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