Friday, June 08, 2007

Who Are These "Youth In Asia" I Keep Hearing About?

After eight years in prison for assisting in the suicides of terminally ill patients, Jack “Dr. Death” Kevorkian was freed last Friday. Like Monica Lewinsky and OJ Simpson, Kevorkian’s notoriety instantly made him fodder for talk show monologues back in the late 90s. His name is still part of American popular culture and may always be synonymous with suicide.

But where those other names made distinctly bad choices (of differing degrees), Dr. Jack had chosen to fulfill one of the primary roles of a doctor – to end suffering – in a very unconventional and, for some, unacceptable way. He created a “suicide machine” that delivered to terminal patients a drug cocktail that would end their lives. These were people who were not only going to die regardless, but who were going to suffer right up until the end. Also, and this is important, they were still of sound enough mind to make their own decisions.

The courts, however, considered this second-degree murder, and sentenced Kevorkian to prison.

The showing of a Kevorkian patient's suicide video on 60 Minutes was probably the final straw for him. I didn't watch, as I found the idea too disturbing. I think it's fair to say, not to make light of a serious subject, that for myself and many Americans, real suicide remains "not ready for primetime." But while watching is one thing, supporting someone else's right to do it is yet another.

When I think of euthanasia I think: How many times have you or someone you care about said (possibly while watching a dramatic TV show or movie) “If I ever end up as a vegetable with no hope like that, I want the plug pulled?” Well that can be done legally, though, like doctor-assisted suicide, it's a form of euthanasia. In Kevorkian’s case the patients may have still been walking and talking, but they were also suffering greatly.

We humans have in our hearts compassion for suffering, and sometimes we make a tough decision to end that suffering. We do this when we reluctantly put a sick, old canine friend down. I know, that’s an animal, but the idea is much the same: Someone/thing I love is suffering, and I don’t want them to suffer any longer. How many people out there sincerely view pets as members of their family? Lots.

In the case of Kevorkian's patients, who better to make a decision about ending suffering than those directly affected by it?

There are many arguments against patient-elected, doctor-assisted suicide as well as "pulling the plug" on the comatose. The main one seems to be honoring the sanctity of human life – and that’s certainly not something to take lightly. But when death is certain, and only pain left before it, who are any of us to tell someone else “no?” And when people are “alive” simply because some instruments plugged into them keep beeping and blinking for years on end, isn’t that really just the illusion of life?

Except for Oregon (I think), no state allows doctor-assisted suicides. That’s yet another reality that’s out of step with public sentiment. A majority of Americans support stem cell research, and Congress has just
passed yet another bill in support of it, but President Bush is planning to veto it again.

As for Kevorkian, he has promised not to break the law anymore (hey, at his age, he can’t really afford more prison time), but also plans to continue to push for the legalization of doctor-assisted suicide. I wish him luck, and I hope he lives to be 100.


Aunty Belle said...

Ain't that simple---once ya' start lettin' docs be killers, whar' does one draw the line?

Ask that in Holland whar' docs admit they kill without consultin' the patient or family--jes' on their own idea of who should or should not go on livin'. The whole thing turns the docs into a parody of what they wanna be. An' palliative care takes care of most of the worst sufferin'. As fer vegetables--they doan know they's suffering.

Thang is Kervorkajerk killed some folks who had hope of help--they was depressed over diagnosis, and others he killed were well enough to take an overdose on their own wif no aid---jes' lack of will to do it. No need to turn our medical folks into killer. Iffin' ya wanna die, ya' can do it yoreself.

she said...

a detail from the hippocratic oath:

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art.

I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work.

i.e. its not a doctors place to do this. agree with aunty, do it yourself or make provisions via living wills. after terry shiavo seems like everybody would have a heads up to make plans for the just in case.

i know you are going to say, what if you cant use your arms to take the pills you hoarded for this occasion? get your buddy to help you out and keep it to yourselves.

i think its a BAD idea to turn over the decision on who sould live and die to the state or the state's minion whatever form that may take.

welcome back to 'merica aunty.

Pete Bogs said...

"i think its a BAD idea to turn over the decision on who sould live and die to the state or the state's minion whatever form that may take..."

as do I... I am asking that the state not be permitted to decide who lives and dies... I am for leaving that up to the patients and their doctors, and the state not interfering as they did here...

the problem with doing this on your own is doctors better what will be both effective and relatively painless... the "solo" suicides are pretty messy affairs...

as for the docs killing patients outright, charge them with murder... I am talking about meeting the criteria of 1) a CHOICE made by the patient who is 2) terminal and is 3) living in pain...

as for the comatose, yeah, you can keep them alive indefinitely, but as I've said, it's only the illusion of life... what kind of life is that? and who's to say what unconscious people may be experiencing?

Bird said...


all i know is - i want to be the one to decide when i go out - when life is enough. right now, i think if i can't have full use of my body i may wish to pull the plug - but i may change my mind as time goes by. as long as my mind is intact - i want to decide.

but i know my destiny - my mind will rot and i will forget where i hid the pills. and i will forget who i was and be only some raving lunatic, smearing feces on the wall. my poor children will suffer the burdern - all because, when i make a living will, there is not legal provision i can insert to pull the plug on me should i become quite incompetent.

just a little over 10 years ago, my father had a massive heart attack and went into a coma. we took him off life support, and sat vigil. at the same time, with a wink and nod to the doc, we requested he not be in pain, that he receive the maximum dosage of morphene to ease his suffering. there's a fine line between an dose of morphene that eases pain and assists death. our hope was that the doc caught our intent, and administered a dose that not only eased my father's pain, but hastened his death as well.

perhaps then, i,my siblings, and my stepmother are killers - murderers. so be it. i have no problem with it.

all societies kill. always have. always probably will. we determine when it is acceptable to kill. kill and murder are not necessarily the same thing.

Aunty Belle said...

Hmmn...there is some misinformation ridin' the airwaves on this subject.

Ya' can have all sorts of livin' wills--that is one animal. Some make clear under what conditions the plug is pulled--Aunty gots one o'them that says no "extraordinary measures" are to be taken if there is no reasonable hope of recovery.
I'se like BIrd--doan want mah chillen's ter have to keep me onmachines and such.

It does call fer nutrition and hydration--thems not extraordianry since all of us need them...but this will does say if I'se on ventilator, and a zillion other life extension machines,there is no need to keep juicing me. NO need to make the body keep going when it is ready ter die.

Ya'll, we'uns cain't confuse takin' folks off of machines with what Kervorkian did--he done pushed folks over the cliff.

It is a whole other thang to give death dealing juice to a live person.

As fer morphine and pain killers--looky, the thang is this: when the intent is to relieve the pain, and the pain is so great that a high dose is needed, if death occurs, then that was not the intent--and a good doc knows that risk.

But none of these fine distinctions was in the Kervorkian cases--nope--he simply shoved folks over the wall. Some of these folks had decent options that could have been explored--he is a macabre death lover. He admitted it--the ride he gets from killin'--like those nurses who were jailed fer killin' patients jes' fer the thrill.

Pete Bogs said...

"Ya'll, we'uns cain't confuse takin' folks off of machines with what Kervorkian did--he done pushed folks over the cliff."

they're both euthansia... and I think you've mischaracterized him... I don't he went around looking for victims to kill, you know, the way we liberals are always looking for a baby to abort... he saw a need and fulfilled it... there are sick people in the world, and there are people with unconventional ideas, and I believe he's the latter... said...

1. how does a clinician distinguish between a person who truly wants to die ... has really though it out and made a balanced decision with a sound mind ... and a person who's fallen into the deepest despair of depression that befalls those with terminal illness? tough call. in essence, a judgement call.

2. how do i know, when i've give a dying (i.e. they have DNR status) patient morphine and ativan for comfort, and they stop breathing, that the drug killed them? how do i know they would not have died anyway d/t their illness/pathology? i don't really.

3. do no harm. indeed ... clinical standards of practice for docs and nurses demand this. what does this mean? does it mean withholding potentially fatal doses of pain medication d/t the risk that you might kill them? or does it mean relieving pain? tough call. incidently, i have heard of cases where nurses got sued for under-medicating dying patients - under-medicating patients b/c they feared the perception ... of euthanizing.

4. if we don't want medical personnel engaging in assisted suicide ... than we should apply this 'thinking' across the board and remove them from the lethal injection process, as well.

5. on one hand i see why terminally ill people want their misery ended. having been that nurse that looks after those patients ... i get that.

but on the other hand ... i don't think its my place to end a life. not even my own. its not mine in the first place and it never was. and the thing that burdened me most about hospital practice was the power of life and death over people.

6. i agree ... we all say relief of suffering makes us want to end life. who suffers more? those who watch? or those who endure? i have watched ... to me its still not clear. it may seem convenient to end the suffering so we can end out experience of powerlessness.

7. i think ... what this leads me to is that suffering exists not for our own purposes. but ... for a larger purpose ... for the purposes of others. this may seem quite esoteric and abstract a view ... but ... after 6 years of chemotherapy and terminal oncology nursing ... that's what i have arrived at.

8. regarding kevorkian. i think his actions seemed sort of vulgar and twisted. and i agree, assisted suicide has no place on television.

9. regarding artificial life support. what defines life? if the person has no spontaneous breathing and no brain wave ... do they still reside in that shell? i suppose the question i would ask is why, then, did we place them on life support anyway ... ?

this is the greyest area of all but i do agree that sanctity of life and mercy dictate that artificial means of sustaining life must have strict limits. because, once we apply the technology to patients, they become borg. it becomes so very difficult to peel away the devices from the human.

i have said that life is not ours to end at our whim. i will also say life is not ours to extend at our whim. when its supposed to end ... we must let it. there's the rub.

my apologies for the epic comment. this issue is near and dear to this former nurse's heart.


Pete Bogs said...

red - thank you (and everyone else) for your comments... I knew this topic would bring out a lot of strong opinions... I usually try for lighter fare on Friday, but this is a current story...

my mother was a nurse for 40 years... she saw it all during her career... and that's part of why she always told us kids DNR... we were forced to have that talk with her and doctors seven years ago after she suffered a cerebral aneurysm... she left the decision up to us kids... she told the doctor that, if it came to that, she wanted "my (her) three boys" to decide... luckily, the DNR order was not necessary... said...

actually in my experience for patients to receive the designation palliative care ~ i.e. admission to palliative care ward ~ they must have a DNR on their chart. that said ... many patients palliate on other wards that don't have such a policy.

and then it becomes contentious for family members. most docs will do as per the family's wishes but some are bold and will make a decision to place a DNR order on the chart without consulting the family. that's when the drama unfolds ...

Pete Bogs said...

red - I wouldn't want the doctor to make the decision for me or a member of my family... it's not his to make...

Aunty Belle said...

HEy Red--I'm hearin' ya'.

Looky, one thang Red touched on, and Aunty might be extendin' a mite is that suffering is sometimes very productive. Not fer the patient per se, but for those who love them. I mean that it brings folks to think hard on ole wounds, forgiveness, their own mortality....we moderns is woefully fearful about suffering.

One other thang--I doan see disconnectin' extraordianry machines as euthanasia. It is passive--that is, give hydration and nutrition, but disconnect ventilator if brain is gone. If the person lives--he is meant to live, if not, false extension of life is not necessary morally/clinically/socially.

The purpose of resucitation is to buy time to perform life saving procedures. This is often true for heart attacks, right?

But DNR is for those already in state of brain dead, severe head trauma, massive stroke--in other words, where little hope of any sort of conscious life is expected.

None of these was Kervork's situation. He was a simple murderer. He took advantage of ill people not yet in terminal stages or who still had pain relief available. He took advantage of depressed persons.

Pete Bogs said...

"But DNR is for those already in state of brain dead, severe head trauma, massive stroke--in other words, where little hope of any sort of conscious life is expected.

"None of these was Kervork's situation. He was a simple murderer. He took advantage of ill people not yet in terminal stages or who still had pain relief available. He took advantage of depressed persons."

as I said in the post, his patients may have been walking and talking, but they would be dead whether Kevorkian helped them or not... this demonization of people with unconventional ideas (yeah, i said it again) is sad and wrong...

LeftLeaningLady said...

Wow, Pete, I guess you stirred up a hornet's nest here. I don't know how I missed it on Friday. I actually did a post on Dr. Kevorkian before he was released and I think you and I are fairly simpatico here.

I do not want doctors to decide when it is my time to go, but I don't want to hang around with no mind, in pain, for years on end, draining the family coffers either. And I think that should be my choice or the choice of my family. Sadly I believe that this is another of those times when people are uncomfortable with a certain topic so they choose to try to legislate it.

If a person does not like the idea of assisted suicide, it is his/her right not to partake of it, no matter where or why he/she believes that way. I just don't understand why that same person can't leave my choices to me, also.

Pete Bogs said...

LLL - thanks... I will have to check out your post...

Bird said...

not to beat a dead horse...or kill a live one...

but there's an arugment here than makes no sense to me:

i will be kept alive or rather, i will be denied the ability to end my life (with or without assistance) because my suffering might serve someone else's purpose - they might learn something from my suffering?

i concur that we can learn from others' sufferings, but don't keep me going just 'cause you might learn a thing or two from my agony.

i ain JC. i'll pass on the marytr stuff. said...

pete ~ not sure how things work there. but ... here, the doc is the one who manages the pt's care/treatment and so, in cases where the patient is incapacitated and has no known living will ... doc makes decision. most will just do as the family requests. some, however, will not prolong what THEY perceive to be futility ... even if this means going against family's wishes. there have been court cases here. the family lost. and a public trustee was appointed. of course, the public trustee does what the doc suggests.

and there actually is quite a universally accepted convention that dictates when two doctors make a decision regarding a patient's treatment, consent from family is not required. this, of course assumes that the patient has no capacity to give informed consent.

regarding: "his patients may have been walking and talking, but they would be dead whether Kevorkian helped them or not"

forgive the flippancy, or just downright smart-assed-ness ... but, given enough time, one could say that about anyone who has been killed.

bird ~ its not as simple or vulgar as that - suffering of one person being the science project of another. i am speaking in a less concrete way than that. but ... like it or not ... it seems to me that's how humanity chooses to (wants to, even) learn, too ... from the suffering of others.

still, i could not ... despite all the suffering i have seen ... i could not bring myself to partake in any action whole sole purpose = to end another's life. call it semantics ... but when i engage in a an action that's designed to promote comfort ... that's one thing. but to walk into a patient's room with a syringe of whatever knowing full well i intended to kill a patient b/c s/he asked me to? b/c s/he purports to suffer so deeply s/he wants to die? i could not. particularly when professional standards of practice clearly state 'do no harm.'

i have a brother who is terminally ill. i would refuse to assist his suicide, if he ever asked.

i never wanted the power of life and death over people when i nursed. in fact, that's why i let my license lapse and stopped practising. so ... i feel no differently now.

in fact, i have recently faced a dark time in which i realized that i feel its not even my place to end the life/existence which i currently live. that's because i believe my life is not mine own. that's b/c i believe it's just something i've channeled from some supernal force.

for one who does not share this belief ... the view may be different.

i could not partake in assisting someone's suicide ... or even committing my own. but ... live and let live, i suppose. as long as those who want to follow that course have an execution plan. i.e. medical personnel should not be asked to violate their standards of practice.

i know a medical practitioner in EU that has assisted suicides for some of his patients. there is a process ~ you don't just walk in and get a shot of KCL in your arm and then die. its a little more involved than that.

having worked in palliative care for a while i honestly think the focus should be more on relief of suffering and making the passage from life to death serene and pain-free ... not shortening the passage from life to death. but, alas, we as a society are always looking for the quick fix.

and ... one more thing ...

it occurs to me to ask ... those of us who champion the right to die so valiantly ... is it partly b/c we simply don't want to have to witness the suffering and passage of life?

just wondering out loud. (i know, its annoying when i do that).

Pete Bogs said...

red - I think the patient or their family has to make a decision here... I could be wrong... certainly, if you have an incapacitated transient ("John Doe") with no family, the doctor makes the call...

regarding walking and talking, I was just distinguishing between those in a vegetative state and those who are terminal...

euthanasia isn't easy and should never be like walking in an office and requesting a shot...

as for who the ending of suffering is for, it's for the patient and their loved ones... more for the patient, though, if they are suffering...

LeftLeaningLady said...

Here in Florida, if there is nothing in writing, a judge makes the decision whether or not to pull the plug for someone in a vegatative state. The family can petition the judge for permission and if there are enough witnesses who knew the person would not want to live like that, the judge will allow it.

Then the parents will fight the husband for 15 years, then the state and local government will get involved and Tom DeLay will diagnos brain activity over the TV. What a great world we live in.