The Appeal of 'Dr. Death'

SARA ENGRAM

December 20, 1992|By SARA ENGRAM

Jack ''Dr. Death'' Kevorkian struck again this week. Only hours after he assisted in the deaths of two more middle-aged women, Michigan Gov. John Engler signed a law that will ban assisted suicides for 15 months, beginning March 30.

But don't underestimate the accomplishments of the doctor who has bedeviled Michigan authorities since the June day in 1990 when he helped an Oregon woman to kill herself in the back of his van. After all, the same law the governor signed contains a provision calling for a commission to study the issue of assisted suicide. Mr. Kevorkian -- his home state has revoked his physicians' license -- has succeeded in putting on the state's agenda an issue that few politicians imagined they would ever face.

Mr. Kevorkian's crusade is macabre, and certainly his methods raise all kinds of ethical warning flags. But the real danger facing Michigan -- and the rest of the country -- is not so much a lone pathologist's flamboyant brand of lethal ''compassion,'' but rather the danger that efforts to stop him will substitute for serious attempts to address the pervasive fear and pain which make his solutions attractive to so many people.

Since his crusade to help people die got widespread attention, there has been a disturbing but revealing split in public reaction. Ethicists, physicians and many other professionals have denounced his actions, while thousands of ordinary people have cheered him on.

And no wonder. Who would want to grow old or infirm in a society that has no better solutions to old age than warehousing the elderly? Or, like one of the women who died this week, suffer from crippling pain in a country where the medical profession is only now beginning to recognize that it might be important to teach physicians something as basic as keeping their patients comfortable?

The clamor for assisted suicide does not arise in a vacuum. Neither should solutions or policies be considered without taking into account the reasons people might want to end their lives.

That kind of overview depends in part on the medical profession's willingness to pay attention to pain -- and to acknowledge that failure to relieve pain can be as serious a breach of faith with a patient as the failure to treat any other symptoms. But in the context of assisted suicide, it is especially important to be clear about pain relief -- why it is important and what it implies.

Pain relievers like morphine not only help make a patient comfortable, they also depress vital signs. As death draws near for terminally ill people, administering enough medication to relieve pain can also significantly impair organ functions. In short, pain relief can hasten death.

Good medical practice has a clear answer to the dilemma: It is more important to keep a patient comfortable than to sustain bodily functions for as long as possible. Put another way, the risk that pain relief will hasten the end of life is a necessary risk in providing humane care.

If her pain had been managed better, would Marguerite Tate have sought out the services of Jack Kevorkian? Her doctors -- and those who treat other people in pain -- ought to be asking themselves some hard questions. Without that kind of self-examination among physicians, the medical profession's loud opposition to attempts to legalize physician-assisted suicide takes on a hollow ring.

Better pain management is one answer to Jack Kevorkian. Coming to terms with age and infirmity is another -- and that may be an even bigger challenge. Given the bleak prospects facing many Americans as they reach their 80s and 90s, it isn't hard to see the appeal of the Kevorkian solution.

Dr. Arthur Caplan, who heads the University of Minnesota's Center for Biomedical Ethics, is calling for President-elect Clinton to appoint a blue-ribbon commission to study aging in America. He suggests that the new secretaries of Health and Human Services and Housing and Urban Development take the lead in this study, since both health care and housing are major problems for the elderly.

Dr. Caplan asks: Can't a country capable of transplanting pig livers into humans come up with better housing solutions for the elderly than a system that separates couples married 60 years simply because there are no provisions to help keep them together in their homes?

Good question.

Fear of aging, fear of pain, fear of uselessness -- all of these contribute to the desperation that would prompt support for Jack Kevorkian.

Efforts to stop him will miss the point unless they address the larger issues that shape the quality of our lives and deaths.

NB Sara Engram is editorial-page director of the The Evening Sun.

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