Earlier this month, I read of the death of "Dr. Death" (as the press so fondly referred to him), Jack Kervorkian. The passing of this man so inextricably linked in the mind of the public with death has caused me to focus quite a bit on life over these warm and waning weeks of Spring.
Perhaps it is just the specter of the turn of a new season, or seeing the recently-graduated celebrating at the local Chinese buffet, but I just am having trouble shedding that sense of the inevitable the death of Kervorkian has triggered. It is a low-calorie version of what the chronically ill and those in chronic pain must experience as they confront the immediacy of death by assistance.
Kervorkian made us consider whether our own mortality was just that---our own. For some, he was a hero: an advocate of the right of the terminally ill to die with dignity. For others, he took advantage of confused people suffering from chronic pain and depression, and a refusal to explore avenues that could potentially lead to wellness; he thus seemed to be almost impatient with cure, and focused on the kill.
Of course, debate, whether it be within oneself or between the most polar of protagonists, regarding end-of-life issues has been ongoing for centuries. In today's society, the debate has as background the promotion of choice in decision making at the end of life, the prominence of self-determination, and modern technology's gift of the ability of health care providers to withhold and withdraw life-sustaining therapies. And in today's society, patients do have the right to refuse treatment, including the utilization of life-sustaining therapies. They also have the right to demand better control of pain, even if it literally kills them.
Do they also have the right to assistance in bringing about death for compassionate reasons?
Euthanasia implies the right to be relieved from pain and suffering, an ultimate expression of autonomy which in the eye of the beholder could contradict or reinforce any and all claims to compassion. It is very difficult for an elderly patient to make decisions regarding that night's evening meal choice, let alone the decision to end life, when that patient is in a fog from the last bolus of morphine.
The reality of motive must be considered in this setting: Is the patient being coerced, perhaps because a generous inheritance is in the offing? Is the patient truly terminal? Is the medical team that god-like that they are able to predict without error the date of demise or the impossibility of pain relief?
This leads to the "slippery slope" arguments that common acceptance of euthanasia will lead to euthanasia for any reason and for anyone. To keep from slipping, we will need a definition of "intolerable pain", a delineation of "terminal conditions", and assurances that euthanasia is not the exit door when recovery in the form of a long hospital stay seems too costly.
Euthanasia should not be simply an easy option for physicians who have deficits when it comes to treating chronic pain, alleviating depression, or bringing a sense of dignity to those they are treating.
Kervorkian at one point asked to leave prison due to poor health, but apparently never considered himself a candidate for assisted suicide. He admitted to being as "afraid" of death as any of us, but he also felt that those who desired death with dignity deserved it. Illness and all, he made it to age 83.
If the death-with-dignity dilemma should befall any of us, will we do what Jack did earlier this month, or will we do what Jack said for all those years?
