Doctors and death

December 05, 1990

Facing a charge of first-degree murder, Dr. Jack Kevorkian now has what he wants: a spotlight focused on physician-assisted suicide. Unfortunately, there are enough troubling ethical considerations in this case that the glare of national attention holds the risk of producing a setback for the rights of patients facing terminal illnesses or incurable and degenerative conditions.

Kevorkian made headlines this past June when he assisted in the death of Janet Adkins, a 54-year-old Oregon woman who sought him out after learning that she had Alzheimer's disease. Adkins, her husband and a friend flew to Michigan, where she met Kevorkian and discussed her desire to die before her condition deteriorated. He agreed to help. In the back of his Volkswagen van, Kevorkian attached Adkins to the intravenous tube of his "suicide machine," a device that allows a patient to flip a switch, changing the intravenous solution from a harmless saline to drugs that cause death within minutes.

Because Adkins actually flipped the switch, she technically caused her own death. But Michigan prosecutors see this as secondary to the fact that Kevorkian's assistance was essential. In their view, his role constituted murder.

Is Kevorkian guilty as charged? Many believe not. Clearly, Janet Adkins wanted to retain control over her life and she knew that her condition would sooner or later leave her a helpless shell of the vibrant woman she had always been. Because she was still in relatively good shape and death was not imminent, her condition was not considered "terminal" at the time of her death. From all indications, her actions were voluntary. Yet by any standard of medical ethics, the decision of hastening the end of a life should be carefully considered. Certainly any physician involved should be someone who has known the patient for more than a few days.

Increasing numbers of patients and their families face wrenching decisions as their conditions deteriorate and death draws near, and many people believe there is an ethically justifiable role for physicians in the decision not to prolong pain and suffering. But devices like Kevorkian's "suicide machine," together with his advocacy of "obitoriums" where people can drop in to die, may end up souring the public debate before it really begins.

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