Dr. Kevorkian, post-mortem

With the recent death of Dr. Jack Kevorkian (aka "Dr. Death"), I find myself reflecting on how he challenged societal norms regarding the controversial subject of assisted suicide. The psychology course "Studies in Death and Dying" I took my sophomore year in undergraduate college was by far the most thought provoking and my first foray into analyzing this particular issue. I haven't really thought about this issue much over the years until hearing of Kevorkian's death last week.

A friend of mine posted a link online recommending the movie "You Don't Know Jack" (2008), a film that chronicles how Dr. Jack Kevorkian started doing assisted suicides and the controversial, legal battles that ensued thereafter. Al Pacino (as Jack Kevorkian), Susan Sarandon, and John Goodman deliver a stunning performance. Highly recommend. I had forgotten I had wanted to see the movie until my friend (unbeknownst to him) reminded me with his posting. While watching it last week, I found myself having various thoughts about it and felt compelled to write about it. I was also curious to see if my thoughts on this subject are any different now than they were my sophomore year of college.

I wrote a few short essays responding to the Kevorkian/assisted suicide controversy as part of my class assignments/final exam in "Studies in Death and Dying." Given this was November 1997 (I was 1 month shy of 20 years old at the time), I wondered if perhaps my views and/or personal feelings about it have shifted dramatically over the last 13 years. I thought I would share what I wrote back then (for fun/curiosity's sake....I found my folder of papers for the class in my closet, which I purposely kept for posterity) and then follow that up with sharing the thoughts I jotted down as I watched "You Don't Know Jack."

November 17, 1997

I believe an individual should have the personal right to choose to end their life. Although Kevorkian has sparked a nationwide controversy with his methods of euthanasia, he still continues to help those that seek his help. I feel he does a thorough job in getting the person to decide if that is what they really want and even makes a videotape of it to make things clearer for legal and personal reasons. The method of euthanasia used is set up to where the individual must turn the machine on themselves and can always pull it out at the last minute. There are almost immediate results and no pain is felt by the dying patient. I don't agree with the ways Kevorkian disposes of the bodies, but I don't feel he is harming the greater community by the duties he's carrying out. One must remember Kevorkian has certain requirements of the patient: he or she must be terminally ill (6 months or less to live) and they must wait a few months to carefully consider the options of euthanasia. Finally, I believe desperate people seek desperate measures when there is little hope left and Kevorkian just provides the means to the solution.

Another short essay of mine for the class...not about Kevorkian, but on a similar note (ie, whether to "pull the plug" on people): The decision to "pull the plug" is surely not an easy one for anyone to face and it's definitely not a black or white issue. It's a gray area of ethics that needs careful consideration, depending on the patient and the patient's condition. I feel that in most cases, the family should have the power to decide what would be best for the person if there's not a will to pre-determine it all. I'm not sure when is the right time to decide. I suppose that if there was even a slim chance the person could come through it I would wait, but in the case such as with Nancy Cruzan, I would have made a judgment call from the start and pulled the plug. However, in the psychology book there was a case about an infant with Down's Syndrome that had a heart condition. He could be cured with the option of surgery, yet the parents refused treatment. To me, that is wrong and selfish. I believe the court system should only get involved if the family and doctors were both unsure of the patient's needs or if the family might have bad intentions for the patient. Most of all though, I feel there should be no fixed decision on who decides to pull the plug because every patient is different (although the family might possibly know what their loved one would want more than anyone else). The entire situation is about playing God and I don't think this issue will ever entirely be resolved by society.

And one more: Assisted suicide, defined as providing the means to help an individual end his or her life, has benefits and drawbacks. Active euthanasia, intentionally assisting the death of someone suffering from a disease, has become a topic of great controversy over the past decade with the workings of Dr. Jack Kevorkian (aka "Dr. Death"). The decision to follow through with this alternative is surely not spontaneous and requires careful planning on the patient's and the doctor's behalf. Pros of this decision include putting the patient "out of misery" from pain and suffering and giving the patient free will to decide what is best for themselves. On the other hand, this can get quite complicated when family and friends oppose the idea, bringing legal and moral ramifications into the picture. In addition, what if the patient feels hopeless that death is inevitable and follows through with assisted suicide before waiting a fair length of time to see if the possibility of living longer and regaining their health could actually occur?! I am still not sure how I feel about assisted suicide. I do not think I could ever go through with it, although I am sure under extenuating circumstances, I might consider it. As for supporting family or friends wanting to do it, I think it would depend on the individual and the type of illness they were suffering from as to whether I would be for or against it. For instance, if an individual was in constant pain and/or had lost touch with reality with nothing to look forward to every day, I would carefully consider how to help them through the process of death through euthanasia. I think I would be looking at a variety of factors, such as overall attitude (how dramatically it has changed since disease/illness set in) toward life and other people, health and amount of physical and mental energy, and how the person regards death (positive vs. negative). Why? The way I perceive life is, why remain living in a quantitative state when there is no quality to sustain it?

Surprisingly (or not too surprisingly?), my thoughts on the topic aren't too far off from where they were in 1997. While watching "You Don't Know Jack," I found myself actually feeling more strongly about respecting the wishes of those who are in great physical pain and wish to end their suffering with assisted suicide. I don't like the term 'suicide' in regard to this very specific request though.

As a clinician working in the mental health field, 'suicide' is connected to mental and emotional illness or anguish....the compulsion to seek and carry out ending one's life (ie, a permanent solution to a temporary mood/problem). How much more weight does it carry when someone is going through physical suffering as opposed to mental illness (ie, no terminal illness)? This is a rhetorical question, of course. There seem to be many more questions it raises for me than clear cut answers. If nothing else, it gets the critical thinking wheels turning in my head.

Why are we (society) quicker to judge and stop someone from making a decision about their quality of life (in this case re: lack thereof due to physical suffering) in favor of "a person must live at all costs" mentality? Would we do this to our pets? If one's dog (or any other animal you'd have as a pet) is suffering from an agonizing and painful terminal illness, do you stand idly by and prolong their suffering for years and years? Most likely, no. Most people, seeing the end is near, will take the animal to the veterinarian to be euthanized. You don't see religious zealots protesting outside veterinarians offices in those instances. Why? Because it's humane and compassionate. It's the right thing to do. The animal cannot verbalize their pain, yet we question and fight a human being's wish to do the same thing under the same circumstances?

One thing that creeped me out while watching the film: religious undertones of this controversial subject. Just as with "beginning of life" issues (ie, protests surrounding abortion), it's likely the same ignorant people holding up their vile, hate spewing religious messages about the "sanctity" of life at anti-abortion events are also using their religious dogma to oppose assisted euthanasia. In one particular scene of the movie, a woman makes known very loud and clear to Kevorkian her religious convictions on the matter....later sifting through his garbage to find paperwork that she hopes will incriminate him in a court of law. What I wondered....what about a person whom isn't religious whatsoever (that wants to end his/her life)?! If you choose to make your own life decision from a religious mindset, that's your prerogative. At the same time, respect others who choose to make their life decision NOT based on any religious context. I just have to add....you don't typically see non-religious individuals or atheists bombing abortion clinics or attempting to intervene with freedom of human rights, choices,etc. No, it's usually the people who believe in "life" that are causing more hate and violence/death in the name of it...Kevorkian's respectful, compassionate crusades being no exception with how he was received by a closed-minded media and conformist society.

There certainly needs to be a structured protocol for assisted euthanasia, such as requesting copies of medical test results and records to confirm the prevalence of physical pain, whether the person is terminal, and a psychological evaluation to rule out mental health disorders. I'm not sure the extent of what Kevorkian's overall assessment covered (other than him videotaping his patients sharing their thoughts, feelings, and verbalizing the decision to die) before he decided to assist in the deaths of his patients. If and when these specifics are ruled out, I believe people have a right to choose on this matter.

Interestingly, I find my views on family members being allowed to make decisions for a dying person has changed since my younger years. Perhaps I'm just more aware of how family members can be quite selfish in the decisions they make (ie, tend to have their own agenda when in the position of making an important decision for another family member vs. how they might make that same decision for oneself), this issue being no exception. There seem to be more family members than not who will clearly go against the wishes of the dying person and keep them alive no matter what, usually in a very controlling/manipulative way. At the same time, if you don't have any existing legal documents to back up your wishes....family members may be the only 'line of defense' with which to go on, sadly.

In the overall scheme of things, it really just boils down to having respect and compassion for an individual's free will....even if it entails the the taboo subject society fears, fights, or tries to avoid "at all costs:" death.