Lessons from Dr. Kevorkian

March 11, 1993

In their haste to stop the spectacle of Dr. Jack Kevorkian's parade of assisted suicides, Michigan legislators may have created a bigger problem.

Until now, Michigan has had no law making it a crime to help in a suicide, thus making it possible for Dr. Kevorkian to assist in 15 suicides so far. Last month, new legislation was rushed into effect, which makes assisting a suicide a crime punishable by up to four years in prison and a $2,000 fine. It is a temporary measure while a commission studies the issue.

Meanwhile, the American Civil Liberties Union is requesting an injunction against the measure, and Dr. Kevorkian has vowed that, if the lawsuit fails, he will challenge the law's constitutionality by continuing with his suicides. This confrontation is producing more heat than light.

Physician-assisted suicide is a more complicated issue than Dr. Kevorkian or his opponents would have us believe. One Michigan medical group worries that physicians will be prosecuted if a patient uses prescription drugs to commit suicide. Other doctors, especially those who treat terminally ill patients, have legitimate fears about the widespread misunderstanding of pain medication. In advanced cases of terminal cancer, for instance, giving a patient enough medication to control pain can suppress vital signs like pulse and breathing. Under this law, some worry that a physician determined to keep a dying patient comfortable could be charged with assisting in a suicide.

However compassionate Dr. Kevorkian's intentions, virtually no one concerned about medical ethics condones his methods. Hard decisions about life and death are made between doctors and patients every day. But they should be made in the context of an established relationship, they should include more than one physician and they should be made in settings which can provide a system of ethical checks and balances. A free-lance suicide doctor is a tragedy waiting to happen.

Yet the widespread support for Dr. Kevorkian says something important. Too many people fear that their physicians will be more concerned about keeping them alive than about keeping them comfortable. If people could be assured their pain would be controlled, that they would be spared needless heroics, that their families would not be bankrupted by medical bills -- in short, if the medical system worked as it should -- physician-assisted suicide would not be an issue. The fact that a maverick pathologist can become a folk hero by helping people die is a sobering indictment of the health care system.

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