On May 12, Dr. Jack Kevorkian attended the suicide of a 27-year-old Michigan man, whose body was left in the doctor's battered van. It was the 23rd suicide that Dr. Kevorkian had attended since 1990.
The victim, Nicholas John Loving, 27, had amyotrophic lateral sclerosis, a degerative nerve disorder known as Lou Gehrig's disease. His mother said the "suicide doctor" brought peace to her son.
On May 8, the Rev. John E. Evans, 78, committed suicide with Dr. Kevorkian at his side. The retired minister suffered from pulmonary fibrosis, a lung disease, according to news accounts.
The deaths were the first since the Michigan Supreme Court rejected the notion last year of a constitutional right to assisted suicide. A short while ago, the U.S. Supreme Court refused to hear the case.
Dr. Kevorkian has steadfastly refused to obey laws and court rulings against assisted suicide. He maintains that suffering people have a right to decide whether they should die.
Dr. Kevorkian's activities have focused national attention on the issues of euthanasia and assisted suicide. His solutions, however, should be viewed with great concern by patients and physicians.
An autopsy showed that Mr. Loving's illness was not yet terminal, and he was not physically capable of causing his own death by carbon monoxide poisoning.
If society accepts euthanasia or assisted suicide it may jeopardize the lives of patients who do not view euthanasia as an acceptable alternative to chronic or terminal illness.
Inclusion of killing as therapy for disease opposes the basic goals of medicine and threatens to erode further public trust in the medical profession.
The issues raised by Dr. Kevorkian's activities have surfaced locally as a result of Maryland House Bill 933, "Terminal Illness -- Physician Aid in Dying."
H.B. 933 addressed physician-assisted suicide. The bill would have made it lawful for a physician to heed a patient's request to die by providing the patient with the knowledge and agents necessary for suicide.
Although the bill was defeated this year, similar attempts are expected in the future. The introduction of H.B. 933 occurred without benefit of a thorough public discussion of the historical and contemporary issues surrounding it.
John M. Cooper's essay "Greek Philosophers on Euthanasia and Suicide" traces the origin of "euthanasia" to ancient Greece.
In that society, a "good death" was one relieved of psychological distress and, when possible, physical distress. Currently, "euthanasia" means deliberately causing death. Recent attempts to legitimize euthanasia include the development of different terms to describe it.
In part, this nomenclature had developed to make a clear distinction between consensual, voluntary euthanasia and that practiced by Aktion T-4, Nazi Germany's involuntary euthanasia program for the disabled, chronically ill, mentally ill or those arbitrarily deemed unfit.
Because the religious proscriptions against euthanasia have weakened, modern society is conducive to this form of killing.
We value efficiency and speed in our daily activities, while seeking immediate gratification whenever possible. Our population is aging, at a time when more emphasis than ever is placed on the attributes of youth. Family structures increasingly exclude the elderly. Most people die in hospitals and not at home. As a result, death and dying have become experiences removed from normal family life and the support of a close-knit community.
Societal and personal financial concerns are likely unspoken factors.
Annual health care expenditures are expected to increase in part because of an increase in the number of elderly with chronic diseases. Up to 75 percent of health care expenditures occur in the last year of life.
Some who would have died in the past survive, cognition intact, but require tremendous amounts of expensive care, rehabilitation and social support. There is fear that Medicare will place increasing financial burdens on patients and their families. Legalized euthanasia would allow individuals to voluntarily limit health care, saving societal and familial resources.
Life but not life
Meanwhile, technological developments have given physicians the power to sustain biological life without guaranteeing cognitive life. People fear the loss of self-control, quality of life and potential suffering these medical technologies represent.
Because physicians have historically excluded patients from medical decision-making, many people view euthanasia as a way to preserve their self-control and quality of life as they die.
Americans have increasingly valued personal autonomy and self-determination. Individuals are now allowed to make life-and-death decisions previously forbidden. Legalized abortion and the right of patients to refuse life-sustaining medical treatment are manifestations of this strenthened personal autonomy.