Kevorkian's latest trial again raised questions about this strange crusader for the rights of the dying and society's attitude toward euthanasia and assisted suicide.
How are we to come to grips with the issues raised by Kevorkian, a man whom even his supporters describe as an amalgam of P.T. Barnum and the Grim Reaper?
And what has Dr. Death taught us about our positions on end-of-life issues?
In a March 1996 Washington Post poll, 51 percent of the respondents favored physician-assisted suicide (54 percent of men and 47 percent of women). The following statistics from that poll received far less attention:
* Although 55 percent of white Americans favored physician-assisted suicide, only 20 percent of African-American respondents favored Kevorkian's methods and morals.
* While 57 percent of the respondents between the ages of 40 and 49 approved of physician-assisted suicide, only 35 percent over the age of 70 did.
* Assisted suicide was favored by only 37 percent of people under the poverty line.
The statistics indicate that age, race and class have a lot to do with our views of assisted suicide. Blacks, the poor and the elderly overwhelmingly disapprove of it. Perhaps their opposition is driven by mistrust of physicians and the health industry's efforts to hold down costs.
Kevorkian has shown us that the medical profession is geared to preserve life even when death is a more desirable outcome. Rather than aggressively treating terminal illnesses, we need to concentrate on making some people with these illnesses pain-free. In a recent study of 4,000 patients who died after hospital intervention, 40 percent were reported to have been in pain "most of the time" during treatment. Although significant medical advances are being made in the treatment of pain, they do not always translate into more effective pain management for the dying.
"Taken together, modern pain-relief techniques can alleviate pain in all but extremely rare cases," according to a 1994 report by the New York State Task Force on Life and Law. Yet the public holds the view that intractable pain is inevitable in terminal illness.
Loss of values
If Kevorkian has taught us a great deal about how we live and die, he also has misled us. He frequently points to The Netherland's enlightened policies on end-of-life issues, but they deserve closer scrutiny.
In 1993, the Netherlands passed legislation establishing specific rules by which physicians could assist terminal patients in their deaths. But the Dutch experience might be far more mixed than Kevorkian would have us believe. In a recent report by the Royal Dutch Medical Society, the Dutch government acknowledged that the original guidelines are no longer being adhered to. Annually, nearly 4,000 people die in The Netherland's by physician-assisted suicide. Of those cases, an estimated 1,000 involve involuntary euthanasia, acts expressly forbidden by the Dutch policy but not prosecuted.
A 1994 Dutch medical commission also recommended the inclusion of psychiatric patients in the guidelines for those covered by the physician-assisted suicide law. The subsequent increase in the number of suicides in The Netherland's recently has led two noted Dutch attorneys to observe: "The creep toward involuntary euthanasia and mercy killing in the Netherlands has gone unchecked, despite legal conditions designed to guarantee voluntariness."
The Dutch experience leads us to another way that Kevorkian has misled us. He presents his typical patient as a rational, thoughtful person who has made an independent decision to end his life, a kind of modern-day Socrates willing to drink the hemlock.
In most of his recent interviews, Kevorkian has stressed pain relief as the most important part of assisting these people. He argues frequently that the people he helps can no longer stand the pain and thus make a choice of quality over quantity of life. But a study in Washington state, which along with Oregon has the strongest physician-assisted suicide constituencies in the country, showed that only 31 percent of terminally ill patients listed pain relief as a motivation in their desire for death.
Seventy-five percent of the patients in the Washington study listed "not wishing to be a burden" as a reason for seeking physician-assisted suicide.
A profile of a more typical candidate for physician-assisted suicide is an elderly, depressive female who thinks of herself as a burden.
Of Kevorkian's first 43 patients, 28 were women, many of whom were not suffering from terminal illnesses. None of these patients received a competent psychiatric evaluation before turning to Dr. Death.
The most disturbing aspect of the Kevorkian affair is neither the self-promoting atmosphere he brings to these tragic cases nor his obvious lack of empathy for his "patients" in their dying moments. What's most distressing is the loss of the values we once cherished.
Before the advent of modern medicine, we died younger and more frequently. Death was something that clung to the lives of those left behind. When we died, our souls went somewhere, and that destination had a kind of metaphysical and moral sense to it. In that age, our anxiety about death stemmed from our fear of eternal condemnation.
In the modern world, anxiety about death has eased, and, consequently, guilt has all but disappeared.
In "Death Comes for the Archbishop," novelist Willa Cather suggests, "Men travel faster now, but I do not know if they go to better things." If Kevorkian has his way, we all might be traveling faster to death, but it is not clear that our age is one that believes we go on to better things.
Stephen Vicchio, professor of philosophy at the College of Notre Dame, also teaches medical ethics in the Robert Wood Johnson Fellows program at the Johns Hopkins Medical School.
Pub Date: 04/04/99
