Assisted Suicide | Jack Kevorkian

Jack Kevorkian’s unorthodox methods drew attention to assisted suicide.

Decades later, Americans still struggle with whether doctors should be allowed to help suffering patients end their lives.

Stigma Around Physician-Assisted Dying Lingers

The video with this article is part of a documentary series presented by The New York Times. The video project was started with a grant from Christopher Buck. Retro Reporthas a staff of 13 journalists and 10 contributors led by Kyra Darnton. It is a nonprofit video news organization that aims to provide a thoughtful counterweight to today’s 24/7 news cycle.


A Right to Die?
By Retro Report | Mar. 23, 2015 | 14:28

“Death is nothing at all,” the English theologian Henry Scott Holland wrote a century ago in a reflection that is often quoted at funerals. Death is but life extended, Holland said: “I have only slipped away to the next room. Nothing has happened. Everything remains exactly as it was.”

The words are as haunting today as they must have been in 1910 when Holland delivered them in a sermon. But in the realms of politics, medical ethics, religion and technological innovation, the reality is that death is far, very far, from nothing at all. It is the source of challenging legal and moral questions, perhaps none more searing than whether doctors ought to be permitted to usher incurably ill patients into that next room. Should they be able to help sufferers end their lives by supplying medication that would make looming death come faster?

Five states, in various forms, countenance doctor-assisted dying. Others are considering it. In California, legislation to permit such assistance is scheduled to receive a hearing this week. A lawsuit in New York that seeks a similar result was filed in State Supreme Court last month by a group of doctors and dying patients. The emotional wallop of these issues is self-evident, and it is captured in the latest installment of Retro Report, a series of video documentaries that explore major news stories of the past — looking back at where we have been to see where we may be headed.

Where better to start than with Dr. Jack Kevorkian, the Michigan pathologist who came to be known as Doctor Death? He claimed to have helped end the lives of at least 130 ailing people. Few Americans were neutral about Dr. Kevorkian, who died in 2011. To some, he was a force for good, a doctor who grabbed the country by the lapels and made it think hard about how to deal with the severe pain that many people endure as the end approaches. To others, though, he was a self-promoting merchant of death, ghoulishly interested in the mechanics of killing more than in palliative care for those in need of it.

To the authorities in Michigan, he was, ultimately, a criminal. He spent eight years in prison on a second-degree murder conviction after he had erased the thin, yet legally indelible, line separating assisted suicide from euthanasia. No longer content with merely providing patients with the means to take their own lives, the doctor did the deed himself, on national television no less.

Euthanasia is not permitted anywhere in the United States. Direct action by a doctor to take a life is deemed a step too far even by states that have no problem with indirect action: letting physicians prescribe pills that patients themselves then swallow. Are these distinctions without significant difference? Dr. Kevorkian believed so. It is the sort of question that lawmakers and judges, too, are called on to answer. Those who brought the New York lawsuit argue that equal-protection rights are violated by an existing state ban on doctor-assisted suicide (or “aid in dying,” as its advocates prefer). How is it, the plaintiffs effectively ask, that doctors in New York are allowed to hasten death for some terminally ill patients by removing life support but are prohibited from hastening it for others by way of a prescription?

Arguments, pro and con, have not changed much over the years. Assisted dying was and is anathema to many religious leaders, notably in the Roman Catholic Church. For the American Medical Association, it remains “fundamentally incompatible with the physician’s role as healer.”

Some opponents express slippery-slope concerns: that certain patients might feel they owe it to their overburdened families to call it quits. That the poor and the uninsured, disproportionately, will have their lives cut short. That medication might be prescribed for the mentally incompetent. That doctors might move too readily to bring an end to those in the throes of depression. “We should address what would give them purpose, not give them a handful of pills,” Dr. Ezekiel Emanuel, a prominent oncologist and medical ethicist, told Retro Report.

But to those in the other camp, the slippery-slope arguments are overwrought. Citing available information from the few jurisdictions where assisted dying is permitted, supporters of “dying with dignity” laws say that those looking for an early exit tend to be relatively well off and well educated. There is no evidence, they say, to suggest that such laws have been used promiscuously by either patients or their doctors. As for the medical association’s ethical judgment, it “focuses too much on the physician, and not enough on the patient,” said Dr. Marcia Angell, a former executive editor of The New England Journal of Medicine. Writing in The New York Review of Books in 2012, Dr. Angell asked, “Why should anyone — the state, the medical profession, or anyone else — presume to tell someone else how much suffering they must endure as their life is ending?”

In this country, Oregon has the most experience with this issue. Its voters endorsed doctor-assisted death in a 1994 referendum and again in late 1997 after the United States Supreme Court ruled unanimously that year that there is no constitutional right to die and that this is a matter for the states to decide. Washington State voters followed Oregon’s lead in 2008. A year later, assisted dying was made possible in Montana by a State Supreme Court decision. In 2013, the Vermont Legislature gave its blessing, and last year so did a District Court judge in New Mexico, a ruling now under appeal.

The Oregon model is widely invoked. To obtain death-inducing medication, a patient must have a terminal illness, with no expectation of living beyond six more months. Two doctors have to attest to that. The patient must also be judged mentally competent, must be able to swallow the drugs and must be the one to ask for them — twice verbally, with each request separated by at least 15 days. Any physician unwilling to take part in this does not have to.

In Oregon’s 17 years of experience with these procedures, starting in 1998, the numbers have steadily risen. There were 24 prescriptions for lethal drugs in 1998. The 2014 figure was 155, according to the state’s Public Health Division. Many people who ask for the medication — typically, one-third — do not use it, for whatever reason. Of the 155 who received prescriptions last year, only 105 died from ingesting the drugs. Presumably, many of the other 50 died as well, just not from medication.

In all, across the 17 years, 1,327 Oregonians received these drugs, and 859 died from taking them. That toll amounts to less than two-tenths of 1 percent of the nearly 530,000 people who died in Oregon during that period. It hardly suggests that assisted death is rampant. But numbers go only so far in the ethical, religious and legal anguishing inherent in so grave a matter.

Those advocating a state-sanctioned right to die, like the groupCompassion and Choices, say momentum is on their side, but it may be too soon to tell. And Henry Scott Holland’s musings, stirring though they are, are unlikely to be much of a guide. “Life means all that it ever meant,” he said. “It is the same as it ever was.”

In America’s juridical and political precincts, it is uncertain if that sentiment still holds true.

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