Physician-Assisted Suicide

By Raed Gonzalez, J.D., LL.M. candidate

The controversy surrounding physician-assisted suicide was sparked anew when the popular TV news show "60 Minutes" aired a video of a man being put to death by Dr. Jack Kevorkian. The video was made by Dr. Kevorkian in an effort to have Michigan authorities prosecute him. But why would someone risk prosecution in such a blatant way? CBS Television stated that Dr. Kevorkian told them he wanted authorities to prosecute him for euthanasia in the hope that if the prosecution failed, it would set a legal precedent to allow the practice. The 71-year-old Dr. Kevorkian stated that he was fighting for himself, because when his time comes, he wants a colleague to be able to do what he asks him to do. Dr. Kevorkian said he would starve himself to death if he is convicted and sent to prison.

The video, not aired by CBS affiliates in Texas, showed Thomas Youk, a wheelchair-bound 52-year-old man who was terminally ill with Lou Gehrig's disease, signing a paper presented by the doctor. Dr. Kevorkian first administered a sleeping medicine, then a muscle relaxer to stop the lungs, then a stronger sedative to halt the heart. The man died as his head dropped back and his mouth dropped open.

The debate surrounding physician-assisted suicide and euthanasia exploded during 1989 and 1990, when a group of physicians argued in favor of the practice as a last resort to relieve patients of suffering, and Dr. Kevorkian, a retired pathologist living in Michigan, assisted a suicide for the first time. In 1991, Dr. Timothy E. Quill also received media attention after disclosing that he had prescribed a lethal dose of barbiturates for a cancer patient who was terminally ill. A grand jury refused to indict him. While the New York Board for Professional Medical Conduct did not condone physician-assisted suicide, it concluded in the particular case that the actions of Dr. Quill were legal and ethically appropriate.

Since 1990, Dr. Kevorkian has aided in the deaths of more than 100 people suffering from terminal diseases. Three times the state of Michigan has charged him with assisted suicide, and three times the state has failed to win a conviction because of loopholes surrounding physician-assisted suicide. He was recently convicted on two misdemeanor charges relating to a confrontation with police. But this time Dr. Kevorkian described what has happened as his first euthanasia, distinguishing it from the assisted suicides in which the individual, rather than the doctor, pulled a string or pushed a button to start the flow of deadly drugs. Michigan state prosecutors are charging him with homicide, premeditated murder, and assisting a suicide.

Michigan voters rejected this year a move to join Oregon as the only state to legalize physician-assisted suicide. Almost 70% of the electorate voted against the initiative. Dr. Kevorkian's activism may have polarized voters far more than would have been the case in other states. Also, Kevorkian himself contributed to the measure's defeat by opposing it as being too bureaucratic and restrictive on doctors. Michigan's two largest physician groups, the Michigan State Medical Society and the Michigan Osteopathic Association, also opposed the measure on the grounds that the bill could create an end of life bureaucracy that could discourage physicians from providing effective palliative care to their terminally ill patients. The bill, for example, imposed penalties on doctors who do not follow the required protocol for suicide assistance. Thus, a physician who prescribed pain medication for a terminally ill patient, with the unintended side effect of hastening death, could face a felony charge and a $50,000 fine.

The response in Michigan contrasts sharply with the situation in Oregon, where voters approved a physician-assisted suicide measure in 1996. Proposed laws legalizing physician-assisted suicide in both California and Washington have also been defeated by voters. Today, nearly all states prohibit assisted suicide and euthanasia. In Illinois, Michigan, and Ohio, assisting suicide is considered murder.

Although physician-assisted suicide poses ethical and moral dilemmas, support for the participation of physicians in the suicide of terminally ill patients is increasing. The Lethal Drug Prevention Act, a federal bill that would have negated Oregon's physician-assisted suicide law, has been officially pronounced dead for the year. The bill would not have banned assisted suicide outright. Instead, it would have done so through the back door by prohibiting the dispensing of controlled substances for suicide assistance. The bill successfully passed the House and Senate Judiciary committees, but intense lobbying by some health and physician groups, coalitions of hospice and the American Medical Association stalled its progress. They were concerned that physicians, fearing prosecution, would be reluctant to provide adequate pain control for terminally ill patients.

Studies suggest that physician-assisted suicide occurs on a regular, however infrequent, basis in the United States. The practice and the lack of convictions therefor suggest that regulation, rather than a ban on the practice, is proper. Since the bans are not enforced, terminally ill patients, their families, and the physicians providing end-of-life care are left without any safeguard or protection. In order to protect them, the individual states should adopt legislation authorizing a dignified, safe, and effective way to permit and regulate physician-assisted suicide or terminal sedation. Although quite controversial, I believe there is a need to legalize the practice of medical assistance in dying as part of end-of-life medical care.