Shifting the Guilt of Dying

ELLEN GOODMAN

May 25, 1993|By ELLEN GOODMAN

Boston. -- This time the news stories got it right. No banner headlines screaming ''Dr. Death Strikes Again.'' No heated descriptions of the ''serial mercy killer.''

When Dr. Jack Kevorkian was found, for the 16th time, beside a dead body, the reporters and copy editors all knew the drill. They wrote, carefully, that he had ''witnessed'' another suicide.

They described the gas mask and the canister of carbon monoxide used by Ron Mansur. They didn't write about euthanasia but about assisted suicide.

After all, it's now three years since Janet Adkins, an Oregon woman with Alzheimer's, traveled to Michigan to seek out the pathologist and his suicide machine. Dr. Kevorkian has become as well known as Dr. Spock. The debate has moved from the sensational to the serious.

The self-described ''obiatrist'' has had his medical license revoked and been charged with murder three times. He forced TC the debate about doctor-assisted suicide out of the ethics class and onto the national agenda. He forced the Michigan legislature to pass a statute forbidding doctor-assisted suicide.

Finally, before he could be charged with breaking that law, last week a Michigan court struck it down on a technicality. Dr. Kevorkian is temporarily, at least, still in business.

Through all this time, reading about one death after another, I have wondered about more than medical ethics and the law. I have wondered why these people went to the Michigan specialist for their deaths.

Janet, Sherry, Marjorie, Susan, Lois, Catherine, Marguerite, Mercella, Jack, Stanley, Mary, Elaine, Hugh, Martha, Jonathon and now Ron were all capable of committing suicide themselves. Most of them had family and friends. Why did they go to Dr. Kevorkian?

I raise this grim question, in part, because Dr. Kevorkian is the last person I would want as my shepherd. This peculiar man never had a live patient before he began dealing in death. His first cause was promoting the harvesting of organs from death-row inmates. His second was a chain of suicide clinics. He does not have the manner for my final bedside moments.

But this question also goes to the heart of the discussion about whether doctors should be allowed, even expected, to assist suicide: Why would we call on them to perform this role or make these decisions? Why doctors?

The simple answer is that doctors have been the gate-keepers of the information and the medicines with which to painlessly end life. The simple answer is that we may require help if we are physically unable to even pick up a vial of pills. People are afraid of botching the job. In pain, ill-health, they turn naturally to their family doctors.

But there are times when the simple answers may be too simple. After all, Dr. Kevorkian is nobody's family doctor.

For that matter, in an era of HMOs and emergency care as primary care, there are fewer intimate doctors. Then too, information about a painless death is widely available today without a doctor.

If the discussion about suicide for the painfully, perhaps terminally, ill has focused on doctors and doctor assistance it may be for another reason. It may be part of the way we are professionalizing everything.

In our culture, birth most often takes place in a hospital. Death does as well. We shift our problems from family and friends to Ph.D.s and M.D.s. We go to doctors with emotional problems. What were once moral problems -- drug abuse, for example -- are now medical problems.

For many people, including the very ill, suicide is also a moral problem. Now, I suspect, some are subconsciously looking to medicine not just for help but for a seal of approval, some official moral permission slip to end their life.

''We haven't squared our desire to make life and death choices with our willingness to take the responsibility,'' says ethicist Art Caplan. ''Instead of swallowing pills in our own room with loved ones, we can have a doctor put a gas mask on. It shifts the guilt.''

Maybe it's fitting that this debate about moral responsibility should take place on Jack Kevorkian's turf. Dr. Kevorkian is a death technocrat, nothing more.

But as the discussion about doctors, patients and the law goes on -- and it will -- the focus also widens. These searing questions require the moral attention of family and friends. Life and death are not just for the professionals.

Ellen Goodman is a syndicated columnist.

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