First, do no harm

May 11, 1994|By Walter Reich

I WAS stunned by the words of a juror who, with his other colleagues, had just voted to acquit Dr. Jack Kevorkian, the Michigan physician tried for helping a terminally ill man gas himself to death with carbon monoxide.

"In the back of a van -- I don't think that's the place for a medical procedure," the juror complained last week after the trial.

What appalled the juror was the fact that a gassing in Dr. Kevorkian's van was so undignified. What appalled me was the fact that this juror and all of the others considered the gassing a legitimate medical procedure.

After watching a wrenching videotape in which the patient expressed a wish to die -- it was made a month before the gassing -- the jury agreed with Kevorkian's contention that his primary aim was to end the patient's suffering.

The jury concluded that the doctor had not broken a Michigan law written specifically to end his string of physician-assisted suicides. That law -- its constitutionality is being considered by the Michigan Court of Appeals -- forbids persons to help others die unless their intent "is to relieve pain and discomfort" rather RTC than cause death.

But by interpreting the law this way, Dr. Kevorkian and the jury were disingenuous.

Even if the object is to relieve pain and discomfort, the inevitable consequence of gassing someone is to kill.

By finding that killing is a legitimate medical procedure, the jury has unleashed a process that may well erode the identities of physicians as healers, turn some into socially sanctioned killers and undermine the trust that all of us must have -- especially when we're desperately ill and want to live -- that our doctors are agents of life, not death.

Worst of all, it pushes Dr. Kevorkian's gassing van down a slippery slope that could well lead to killing people who have not asked to die.

To be sure, even now physicians participate in the deaths of patients, largely through acts of omission. Though their ultimate duty is to preserve life, there are circumstances in which that duty is not carried out.

When the patient is in a coma from which he almost certainly will never emerge or has an intractably painful, inevitably terminal and rapidly progressive condition that has brought him very dose to death, physicians may decide that withholding aggressive treatment designed to extend life at all costs is proper.

This decision becomes easier if the patient has clearly expressed, in a living will similar to Richard Nixon's, that he wants to be allowed to die without the use of a respirator or any other device or treatment that would prolong suffering and result in an intellectually or physically debilitated condition.

Under such circumstances, the physician's proper duty is the preservation of the patient's comfort and dignity, not his life.

Sometimes physicians perform acts that cause or hasten death but that conform to law and medical ethics. They do this when they administer pain-relieving medications to patients with advanced terminal conditions after advising the patients that the risk of death would thereby be increased.

Such treatments, like high-risk surgical procedures, are intended not to kill but to improve the quality of life even though they might prove fatal.

All of this is different from Dr. Kevorkian's practice of assisted suicide carried out with 20 patients during the past four years. His goal in each case was to kill the patient after they asked for his help.

Some were terminally ill, suffering immensely and very close to death. Others were not. The fact that not all of Dr. Kevorkian's patients

were near death or in extreme suffering underscores the medical and social nightmare that his acquittal portends.

If the floodgates of legalized and formalized medically assisted suicide were opened so that it became fully legal for physicians to respond to patients' requests for help to die, requests would pour in that would not resemble the extreme ones now used to justify such help.

No matter how many restrictions were put in place to limit the circumstances under which physicians might assist in suicides -- for example, the patient is near death, in severe pain and free of suicidal depression -- such restrictions could never be made tight or clear enough to totally bar assistance to those who did not qualify.

Such individuals might have a significant life span ahead but prefer, for a variety of reasons, not to live. They might have pain that is, in fact, controllable by medications, feel discouraged because they cannot function at the same level they once did or believe that their illness burdens their family.

This could lead them to try to convince doctors that they should be helped to die and doctors could accede to their wishes.

Finally, some families -- for financial or other reasons -- might put pressure on physicians to take active measures leading to death.

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