Human Nature

Life After Kevorkian

He fought for the right to assisted suicide. Now what should we do with it?

Dr. Jack Kevorkian

Jack Kevorkian is dead. He didn’t kill himself. But after years of failing health, he received his own medicine: a merciful end. He was 83.

So was my father. Two months ago, my dad passed away. Like Kevorkian, he had cancer. He saw the end coming. He rejected chemotherapy, turned to hospice care, and went home to die.

I spent weeks with him. He was at peace with the prospect of oblivion. Two weeks before he died, a group of friends came over to toast him. They said they were really going to miss him. “Well,” my dad joked, “Since I don’t believe in an afterlife, I’m not going to miss you.”

Death was OK. But suffocation wasn’t. His body, filling up with cancer, couldn’t breathe. I saw the anxious look in his eyes, heard the plaintive tone as he asked the nurse for a little extra morphine. She stared back, gauging him.  This, I learned, is what good caregivers do. They don’t shut you down or hasten your death the first time you ask. They want to be certain you need it. They want to make sure that what’s coming out of your mouth is your will, not just a moment of panic.

I always thought Kevorkian was basically right about assisted suicide. I figured that if my parents ever wanted to end their lives, I’d find the pills and help them. But reality turned out to be more complicated. I heard my father on the phone telling friends he was ready to go. “If I had a euthanasia option, I would take it,” he told one well-wisher, “because there are very few interesting things left for me to do.” His words chilled me. This was not a man tortured by pain. His breathing was fine that morning. His mind was intact. His body seemed to be rallying. But he was stuck in a wheelchair, too winded to talk much, and too often alone. He was bored. The thought of him taking suicide pills, when a game of cards might do, shook me up.

Kevorkian, cut off from mainstream medicine, was lax about investigating palliative options and verifying that his patients were terminally ill. And he didn’t know where to stop. For years, he provided lethal drugs but left the suicidal act to his clients. Then, faced with a patient too physically impaired to do the job, Kevorkian injected the drugs himself. For that, he went to jail.

But he brought assisted suicide out of the shadows, and behind him came a wave of reformers more careful about drawing lines. Oregon’s Death With Dignity Act, for example, requires the attending physician to 1) inform the patient of “feasible alternatives, including … comfort care, hospice care and pain control,” 2) “inform the patient that he or she has an opportunity to rescind the request at any time and in any manner, and offer the patient an opportunity to rescind at the end of the 15-day waiting period,” 3) “refer the patient to a consulting physician … for a determination that the patient is capable and acting voluntarily,” and 4) “verify, immediately prior to writing the prescription for medication … that the patient is making an informed decision.”

My father, like Kevorkian, never had to kill himself. But I saw the morphine and the pills. I learned to calibrate and fill the syringe. I sat with him as the hospice nurses quizzed him about pain and breathing. I saw the dosage go up or down with his labor and anxiety. They promised to protect him from suffering. We all knew what that meant. And this is what happens every day, not in a rusty van, but in loving homes around the world.

That’s where these decisions belong. And that’s how they should be made. Assisted suicide, it turns out, is a lot like abortion. No government can stop it—I would have risked jail to get the pills if necessary—and efforts to enforce its prohibition only make it less careful and humane. But, like the right to abortion, it can be abused. People want to die for all sorts of reasons. Sometimes it’s agony. Sometimes it’s boredom. Sometimes it’s fear. Maybe your mother needs a lethal prescription. Maybe she needs antidepressants. Maybe you just need to hold her hand.

Kevorkian didn’t have the answers. But he raised the right questions. We can’t criticize his flaws, temper his ideas, and praise the hospice movement without acknowledging what he did. He forced an open conversation about the right to take your own life. Under what conditions, and within what limits, should that right be exercised? Even if it’s legal, is it moral? What do you do when a loved one wants to die? Kevorkian didn’t take those questions with him. He has left them to us.

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