Assisted Suicide in Canada (Part V): Keep Physician-Assisted Suicide Illegal — and Sometimes Look the Other Way
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
In 1997, I helped supervise a physical and psychological autopsy study of the late Jack Kevorkian’s first 47 cases of physician-assisted suicide (PAS) conducted by the Detroit Free Press. We found a number of disturbing patterns. The physical condition of these PAS patients was not typical of conditions that led to death among American patients. Specifically, only 31.1 per cent of these patients were judged to be terminal. While 73.9 per cent were described as reporting pain, only 42.6 per cent were revealed at autopsy to have a specific anatomical basis for their pain. 36 per cent were described as depressed, 66 per cent as having some disability, and 90 per cent as expressing a fear of dependency.
Perhaps most troubling is the large gender differences that emerged, over two-thirds of PASs were women, a complete reversal of the usual gender pattern for completed suicide in America. Autopsies revealed that although close to 75 per cent of both men and women among Kevorkian’s suicides were described as having reported pain, autopsies revealed that his male suicides were twice as likely to have shown an anatomical basis for that pain as were women, and three times more likely to be terminal (less than six months to live). However, Kevorkian’s women were more likely to be described as depressed than were his men.
Finally, Kevorkian’s physician-assisted suicides tended to be older than the typical unaided suicides in America. In other words, gender, disability, and age biases seem to run like thin red threads through the people he selected for his “special treatment.”
Looking at these patterns, it isn’t hard to imagine legislation permitting assisted suicide and euthanasia resulting in more chance for abuse, both by the financially driven choices in health care, and families who wished their loved ones dead. The pattern also suggests the possibility of the extension of assisted suicide to physically sound but depressed individuals and as a “quick” solution for the elderly when they feel useless. Philosophically, it would lead to the substitution of “death with dignity” for “meaning of life” and a shift from death as a fact to death as a right. This is to say that death will become a concern with the legal issues as opposed to the psychological and spiritual. We will find that Kevorkian’s abuses will not be limited to Kevorkian himself.
Martha Wichorek, one of Kevorkian’s later cases, sent me numerous letters in her last days and a number of suicidal themes stand out. Ms. Wichorek displayed black and white negative thinking, a counter-phobic stance toward dependency (rejection of all help or assistance), and an insistence on a non-biological definition of life (as being able to take care of oneself). She regularly used euphemisms (she created a new life stage — “miserable existence” — rather than describing herself as feeling miserable), would speak for others unsolicited (she advocated for a state-sanctioned euthanasia clinic for “we [the] terminally ill, elderly, Alzheimer’s,” even though she personally fell into none of these categories), and she had a reluctance to accept family support (she found death preferable to living with her children).
Indeed, Ms. Wichorek had an overly rational and legalistic analysis of the problem of euthanasia and physician-assisted suicide, exaggerating annoying but relatively minor and temporary discomforts, leading to an irrational tunnel vision behind her seemingly logical arguments. She often blurred her personal situation with the campaign to legalize euthanasia and the eagerness to make herself a martyr for the cause. She emphasized her choice to die (and be in control) rather than accept her current relatively healthy though somewhat diminished state. Would legalizing physician-assisted suicide allow participation of physicians in a death such as this one?
Many contemporary forces, often economic, are working to turn the default in medicine from patient life to death. This must be combated with all our strength. Legalizing physician-assisted suicide is opening a door that will not be so easy to close. I strongly advocate keeping it illegal, and looking the other way upon rare occasions. Martha Wichorek wrote to me that physician-assisted suicide is rational suicide. It appears to me that it is more rationalized than rational, with potentially lethal effects.
Dr. Kaplan is a Professor of Psychiatry at the Unversity of Illinois-Chigago School of Medicine. He is a guest contributor to Juris Diction.
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To read Jonathan Nehmetallah’s introduction piece, visit Part I by clicking here. For Katherine Deakon’s opinion piece, visit Part II here. For medical student Sophie Palmer’s article, visit Part III here. Dr. Udo Schuklenk’s article can be found here.