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Patient Assisted Suicide: Dr. Quill and Dr. Kevorkian
There are many different methods of approaching patients facing the
end of their lives. Since technology has increased the ability to sustain
life longer, patient assisted suicide has become an increasingly more
popular avenue for doctors to explore. This topic, since it deals with
the power over life and death, touches on some of the deepest of human
feelings. The argument over whose or which approach is most viable can
become a heated one and could never be solved with one broad stroke since
it deals with individuals on such an intimate level. Both Dr. Jack
Kevorkian and Dr. Timothy Quill have there own views on which methods are
correct, some of their views are similar and some are quite different.
Both doctors agree that certain people at the end of their lives shouldn't
have to suffer any more than they have to, but they differ in the methods
in which lead up to the decision process of choosing euthanasia or not.
The belief that individuals facing terminal illnesses and or
certain death in a short period of time should have the "right to die with
as much control and dignity as possible" is shared by both Kevorkian and
Quill (Quill 434). There are many cases in which people become sick and
life becomes an endless episode phasing between unconsciousness and severe
pain. There are also cases in which an individual becomes diagnosed with a
disease with no definite cure and faces a road of painful treatment and
emotional heartache . One example of this was Diane's case. Diane was one
of Dr. Quills patients who was diagnosed with "acute myelomonocytic
leukemia", a disease with a 25% survival rate with treatment and certain
death in at most a few months without treatment (Quill 434). This disease
is very painful to say the least. She was faced with the decision between
a painful treatment process or death. Diane chose to let the disease run
its course, this way she would be able to say her final good-byes to her
family. Her only worry was that in the final stages of her death, would
she be able to control herself, or would she slip away in agony. To avoid
this she asked Dr. Quill if he would give her a prescription for
barbiturates so that when the end was near she would be able to control her
death. At first, Quill was apprehensive about her decision, but after
careful thought he decided that assisting in her suicide would be the most
beneficial course of action for her and her family (Quill 437). He
realized that the treatment of the leukemia would be very painful and
traumatic, and that the pain she was certain to face was unnecessary. His
belief is that as a doctor, it is his responsibility to serve his patients
in whatever way he feels most beneficial. He states his opinion most
clearly when he says:
"The Hippocratic oath really has two dimensions. One is
to preserve life and the other is to relieve human suffering.
Usually you are trying to do both but in end of life care you
take relief of suffering as your priority, and you may use
methods that may indirectly shorten life. People have a sense
of who they are and what's important in life and want to die
with that in tact."(Quill 138)
It seems as though the essence of his work is to maintain an individual's
quality of life even if it means death. In Diane's case, he risked his
career and a possible jail sentence in order to make sure that he helped
her in whatever way was best, and so he would be able to live with himself.
Dr. Kevorkian shares the belief that a patient should in certain
cases be allowed to chose assisted suicide if it means that they will avoid
unnecessary pain and suffering. He has had far more cases of patient
assisted suicide than Dr. Quill has, but their reasons are similar.
Recently one of Kevorkian's cases was featured on "DateLine", a news
program, in which a man named Thomas Youks was suffering from Lou Gehrig's
disease. He called upon Dr. Kevorkian because his disease was causing him
a lot of pain and he was afraid that he was going to choke himself. His
condition made it hard to eat, hard to sleep and hard to breath, for Tom
Youks every minute of life was a struggle. Dr. Kevorkian talked with him
and his family and made sure that assisted suicide was what they wanted
this way he couldn't be implicated. They all agreed so Tom said his good-
byes and slipped peacefully away after receiving the lethal medicine from
Dr. Kevorkian. Similar to Dr. Quill, Doctor Kevorkian believed that this
type of situation called for few options other that assisted suicide.
Though Both Doctors agree that Assisted suicide is a viable option
in certain circumstances, their methods of care before the decision is
quite different. Dr. Quill states in an interview from people magazine
that he believes firmly in the doctor patient relationship. "Everything I
[Quill] do has to do with the long haul and careful assessment and making
sure this [assisted suicide] is the last resort and that every patient has
good access to hospice care and palliative care"(Quill 138). Dr. Quill
feels that a doctor should first care for the patient and try to make them
as comfortable as possible, then if the situation truly calls for something
else, assisted suicide is brought into the picture. This care is not only
for the patient but is extended to the patient's family. It is also
important to attend to both the psychological needs of the patient, not
just the physical. In the case of Diane he had developed a relationship
with her and her family. He was in the proper position to aid in t heir
decision because he knew them. He also believes that it is important to
inform the patient of all their options. He is a friend to those he helps
not just a doctor, that is what is important.
Dr. Kevorkian on the other hand lacks in almost all of these
aspects. He meets his patients for the most part by their contacting him
to perform assisted suicide. He only spends about a week with them. In
Tom's case he was with him only a few short days. According to Dr. Quill
"he has frequently acted without knowing people in even the most
superficial way. He has no experience in end of life care... He is a
pathologist, so he doesn't have the skills in pain management and
psychological assessment"(Quill 138). Dr. Kevorkian is not involved in the
decision process, but only in the act itself. It is this that truly
separates the two doctors.
Though both Dr. Quill and Dr. Kevorkian are active supporters in
patient assisted suicide, I believe that Dr. Quill is everything that Dr.
Kevorkian is not. I believe that Dr. Kevorkian leaves out the most
important part of the process of assisted suicide. It is the care and true
assessment of all the aspects involved that is missing from Jack Kevorkian.
When it comes to having a figure in the spotlight I feel that it should be
Timothy Quill not Jack Kevorkian. If patient assisted suicide were to be
made illegal, Dr. Quill should be it's model, not Jack Kevorkian. This is
true because the most important aspect of the process is the comfort, care
and information that leads up to the decision, not just the number of
patients that you see.
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The right to assisted suicide is a significant topic that concerns people all over the United States. The debates go back and forth about whether a dying patient has the right to die with the assistance of a physician. Some are against it because of religious and moral reasons. Others are for it because of their compassion and respect for the dying. Physicians are also divided on the issue. They differ where they place the line that separates relief from dying--and killing. For many the main concern with assisted suicide lies with the competence of the terminally ill. Many terminally ill patients who are in the final stages of their lives have requested doctors to aid them in exercising active euthanasia. It is sad to realize that these people are in great agony and that to them the only hope of bringing that agony to a halt is through assisted suicide.When people see the word euthanasia, they see the meaning of the word in two different lights. Euthanasia for some carries a negative connotation; it is the same as murder. For others, however, euthanasia is the act of putting someone to death painlessly, or allowing a person suffering from an incurable and painful disease or condition to die by withholding extreme medical measures. But after studying both sides of the issue, a compassionate individual must conclude that competent terminal patients should be given the right to assisted suicide in order to end their suffering, reduce the damaging financial effects of hospital care on their families, and preserve the individual right of people to determine their own fate.
Medical technology today has achieved remarkable feats in prolonging the lives of human beings. Respirators can support a patient’s failing lungs and medicines can sustain that patient’s physiological processes. For those patients who have a realistic chance of surviving an illness or accident, medical technology is science’s greatest gift to mankind. For the terminally ill, however, it is just a means of prolonging suffering. Medicine is supposed to alleviate the suffering that a patient undergoes.Yet the only thing that medical technology does for a dying patient is give that patient more pain and agony day after day. Some terminal patients in the past have gone to their doctors and asked for a final medication that would take all the pain away— lethal drugs. For example, as Ronald Dworkin recounts, Lillian Boyes, an English woman who was suffering from a severe case of rheumatoid arthritis, begged her doctor to assist her to die because she could no longer stand the pain (184). Another example is Dr. Ali Khalili, Dr. Jack Kevorkian’s twentieth patient. According to Kevorkian’s attorney, “[Dr. Khalili] was a pain specialist; he could get any kind of pain medication, but he came to Dr. Kevorkian. There are times when pain medication does not suffice”(qtd. in Cotton 363). Terminally ill patients should have the right to assisted suicide because it is the best means for them to end the pain caused by an illness which no drug can cure. A competent terminal patient must have the option of assisted suicide because it is in the best interest of that person.
Further, a dying person’s physical suffering can be most unbearable to that person’s immediate family. Medical technology has failed to save a loved-one. But, successful or not, medicine has a high price attached to it. The cost is sometimes too much for the terminally ill’s family. A competent dying person has some knowledge of this, and with every day that he or she is kept alive, the hospital costs skyrocket. “The cost of maintaining [a dying person]. . . has been estimated as ranging from about two thousand to ten thousand dollars a month” (Dworkin 187). Human life is expensive, and in the hospital there are only a few affluent terminal patients who can afford to prolong what life is left in them. As for the not-so-affluent patients, the cost of their lives is left to their families. Of course, most families do not consider the cost while the terminally ill loved-one is still alive.When that loved-one passes away, however, the family has to struggle with a huge hospital bill and are often subject to financial ruin.Most terminal patients want their death to be a peaceful one and with as much consolation as possible. Ronald Dworkin, author of Life’s Dominion, says that “many people . . . want to save their relatives the expense of keeping them pointlessly alive . . .”(193). To leave the family in financial ruin is by no means a form of consolation. Those terminally ill patients who have accepted their imminent death cannot prevent their families from plunging into financial debt because they do not have the option of halting the medical bills from piling up. If terminal patients have the option of assisted suicide, they can ease their families’ financial burdens as well as their suffering.
Finally, many terminal patients want the right to assisted suicide because it is a means to endure their end without the unnecessary suffering and cost. Most, also, believe that the right to assisted suicide is an inherent right which does not have to be given to the individual. It is a liberty which cannot be denied because those who are dying might want to use this liberty as a way to pursue their happiness. Dr. Kevorkian’s attorney, Geoffrey N. Fieger, voices the absurdity of curbing the right to assisted suicide, saying that “a law which does not make anybody do anything, that gives people the right to decide, and prevents the state from prosecuting you for exercising your freedom not to suffer, violates somebody else’s constitutional rights is insane” (qtd. in Cotton 364). Terminally ill patients should be allowed to die with dignity. Choosing the right to assisted suicide would be a final exercise of autonomy for the dying. They will not be seen as people who are waiting to die but as human beings making one final active choice in their lives. As Dworkin puts it, “whatever view we take about [euthanasia], we want the right to decide for ourselves . . .”(239).
On the other side of the issue, however, people who are against assisted suicide do not believe that the terminally ill have the right to end their suffering. They hold that it is against the Hippocratic Oath for doctors to participate in active euthanasia. Perhaps most of those who hold this argument do not know that, for example, in Canada only a “few medical schools use the Hippocratic Oath” because it is inconsistent with its premises (Barnard 28). The oath makes the physician promise to relieve pain and not to administer deadly medicine.This oath cannot be applied to cancer patients. For treatment, cancer patients are given chemotherapy, a form of radioactive medicine that is poisonous to the body. As a result of chemotherapy, the body suffers incredible pain, hair loss, vomiting, and other extremely unpleasant side effects. Thus, chemotherapy can be considered “deadly medicine” because of its effects on the human body, and this inconsistency is the reason why the Hippocratic Oath cannot be used to deny the right to assisted suicide. Furthermore, to administer numerous drugs to a terminal patient and place him or her on medical equipment does not help anything except the disease itself. Respirators and high dosages of drugs cannot save the terminal patient from the victory of a disease or an illness. Dr. Christaan Barnard, author of Good Life/GoodDeath, quotes his colleague, Dr. Robert Twycross, who said, “To use such measures in the terminally ill, with no expectancy of a return to health, is generally inappropriate and is—therefore—bad medicine by definition” (22).
Still other people argue that if the right to assisted suicide is given, the doctor-patient relationship would encourage distrust. The antithesis of this claim is true. Cheryl Smith, in her article advocating active euthanasia (or assisted suicide), says that “patients who are able to discuss sensitive issues such as this are more likely to trust their physicians” (409). A terminal patient consenting to assisted suicide knows that a doctor’s job is to relieve pain, and giving consent to that doctor shows great trust. Other opponents of assisted suicide insist that there are potential abuses that can arise from legalizing assisted suicide.They claim that terminal patients might be forced to choose assisted suicide because of their financial situation.This view is to be respected. However, the choice of assisted suicide is in the patient’s best interest, and this interest can include the financial situation of a patient’s relatives. Competent terminal patients can easily see the sorrow and grief that their families undergo while they wait for death to take their dying loved ones away. The choice of assisted suicide would allow these terminally ill patients to end the sorrow and griefof their families as well as their own misery. The choice would also put a halt to the financial worries of these families. It is in the patient’s interest that the families that they leave will be subject to the smallest amount of grief and worry possible.This is not a mere “duty to die.” It is a caring way for the dying to say, “Yes, I am going to die. It is all right, please do not worry anymore.” Further, legalization of assisted suicide will also help to regulate the practice of it. “Legalization, with medical record documentation and reporting requirements, will enable authorities to regulate the practice and guard against abuses, while punishing real offenders”(Smith 409).
There are still some, however, who argue that the right to assisted suicide is not a right that can be given to anyone at all. This claim is countered by a judge by the name of Stephen Reinhardt. According to an article in the Houston Chronicle, Judge Reinhardt ruled on this issue by saying that “a competent, terminally-ill adult, having lived nearly the full measure of his life, has a strong liberty interest in choosing a dignified and humane death rather than being reduced at the end of his existence to a childlike state of helplessness, diapered, sedated, incompetent” ( qtd. in Beck 36). This ruling is the strongest defense for the right to assisted suicide. It is an inherent right. No man or woman should ever suffer because he or she is denied the right. The terminally ill also have rights like normal, healthy citizens do and they cannot be denied the right not to suffer.
The right to assisted suicide must be freely bestowed upon those who are terminally ill. This right would allow them to leave this earth with dignity, save their families from financial ruin, and relieve them of insufferable pain. To give competent, terminally-ill adults this necessary right is to give them the autonomy to close the book on a life well-lived.
Barnard, Christaan. Good Life/Good Death. Englewood Cliffs: Prentice, 1980.
Beck, Joan. “Answers to Right-to-Die Questions Hard.”Houston Chronicle 16 Mar. 1996, late ed.: 36.
Cotton, Paul. “Medicine’s Position Is Both Pivotal And Precarious In Assisted Suicide Debate." The
Journal of the American Association 1 Feb. 1995: 363-64.
Dworkin, Ronald. Life’s Dominion. New York: Knopf, 1993.
Smith, Cheryl. “Should Active Euthanasia Be Legalized: Yes.” American Bar Association Journal April 1993. Rpt. in CQ
Researcher 5.1 (1995): 409.
--Esther B. De La Torre