The term "euthanasia" comes from the Greek words meaning "good death." But the concept of an easy death -- specifically, the means of inducing one -- has had a stormy relationship with the law.
The case of Dr. Jack Kevorkian and his suicide machine is a good example. For several years, Dr. Kevorkian had been looking for customers for his device. Last June he found one in Janet Adkins, a 54-year-old Oregon woman who had been diagnosed as having Alzheimer's disease.
Janet Adkins' death in the back of Kevorkian's van in Oakland County, Mich., gained nationwide attention for Kevorkian and his suicide machine, as well as for the notion of controlling the time and means of one's death.
Many Americans applauded Kevorkian and his willingness to break taboos in order to give people this control. Others were appalled that a physician would seek to become, in effect, "Dr. Death."
Michigan prosecutors sided with the latter group and succeeded in getting an injunction barring Kevorkian from any further involvement in assisting suicides. More recently, they charged him with first-degree murder. The charge was dismissed by the trial judge, who cited the fact that Janet Adkins herself flipped the switch that changed a harmless intravenous saline solution to a mixture of lethal drugs.
However, Kevorkian did come to trial Jan. 4 in a civil case to determine whether to lift the injunction barring him from using his invention. Oakland County Circuit Court Judge Alice Gilbert heard testimony on both sides and will issue a ruling in the matter.
Once again, a courtroom has become the arena in which Americans grapple with wrenching issues of life and death.
Some observers, including Dr. Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota, see the legal process as the only realistic way of sorting out the ethical issues at stake.
Caplan says he is less concerned with convicting or penalizing Kevorkian than with taking a good look at the questions this incident raises -- questions that go beyond the rights or wrongs of assisted suicide.
For one, Caplan notes that there is Kevorkian's own conflict of interest. Should the inventor of a suicide machine be the person to operate it? Given his crusade to publicize the device, should he also be counseling patients who want to use it?
A related issue is whether a physician should be involved in such pursuits at all. Suicide has been decriminalized and many people quietly plan their own deaths. Is there really a need for physicians -- the people we entrust with saving lives -- to take an active role in bringing on death?
A third issue that troubles ethicists is the matter of timing. Janet Adkins was beginning to lose some of her abilities, but only a few days before her death she was playing tennis. According to her physician in Oregon, she could have had several more good years. Was it appropriate for a doctor to help her cut short her life?
These issues tended to get lost last summer as people took sides on the concept of assisted suicide. But it is the extenuating circumstances that make each case, and each life, different from every other one. The challenge lies in learning to assess the needs of individual patients and families within the bounds of accepted ethical principles.
However much Americans might support the notion of retaining some control over their deaths, few people want to devalue the principle that life should not be given up lightly.
For now, the job of balancing those concerns has landed in the laps of judges. Better there than in the back of Dr. Kevorkian's van.
Do you have a question about mortality? Send your comments and questions to Sara Engram, Mortal Matters, The Evening Sun, P.O. Box 1377, Baltimore, Md. 21278.
Universal Press Syndicate