Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, March 23, 1993 TAG: 9303230131
SECTION: EXTRA PAGE: 1 EDITION: METRO
SOURCE: Jane Brody The New York Times
DATELINE: LENGTH: Long
IS DOCTOR-AIDED SUICIDE EVER RIGHT?
As an unstoppable cancer ravaged my mother's 49-year-old body, she tried twice to hasten her inevitable death, first by slashing her wrists and then by swallowing rubbing alcohol. Both times she was "rescued," forcing her to suffer further unrelenting insults to her once stalwart figure and boundless energy.Unable to retain food, she withered to 65 pounds, half her original weight, all the while yearning to be out of her misery.
But instead of heeding her demonstrated wish to die and easing her way with, say, an overdose of sleeping pills, at her doctor's request we allowed her to serve as a "test animal" for possible new drugs against her kind of cancer, causing her to suffer further from the toxic effects of the medications.
It seemed altruistic, even noble, at the time, but in retrospect it was cruel and inhuman punishment to a dignified woman who had already served society as an inspiring teacher for 32 years.
When my mother died in 1958, no health professional in his or her right mind would have openly helped her to end her life when to her it had become no longer worth living. Today doctor-assisted suicide is a subject of vigorous debate, national headlines and state legislation.
Extremists on both sides - Dr. Jack Kevorkian of Michigan and his suicide machine and the Hemlock Society's published prescriptions for self-destruction on the one side and fundamentalist religious groups and traditional medical ethicists on the other - have galvanized feelings on an issue that deserves more rational consideration.
The importance of the issue will loom even larger as medicine continues to devise ways to prolong life, at least as it is biologically defined, and as health-care costs at the end of life continue to zoom into the stratosphere.
Society at least partly sanctions two forms of what might be called doctor-assisted deaths, steps that hasten the end for terminally ill people.
One is the withholding of treatment, including breathing assistance and tube feeding; the other is the administration of high doses of narcotics to relieve pain or other symptoms. But for a doctor actively to help a patient die is outlawed in 37 states.
Still, untold numbers of doctors have in one or more cases gone outside the law. They have surreptitiously provided the means to a quicker end for patients they may have tended for months or years. Now, rather than continuing to risk prosecution, many are asking that doctor-assisted suicides be legalized in certain well-defined instances.
Advocates emphasize that because it is predicated on a request from the patient, doctor-assisted suicide is quite different from active euthanasia, in which a doctor or nurse might decide to end a patient's suffering, even when the patient has not sought such intervention. Still, there is a real fear that sanctioning assisted suicides might lead to abuse.
For example, institutions or insurers forced to sustain waning lives at exorbitant cost might be tempted to use assisted suicide to control costs. Another concern is that patients who cannot speak for themselves or fully comprehend their circumstances might be coerced into choosing death rather than becoming burdens on their families or society.
Dr. Timothy E. Quill, who has written eloquently on the subject, says there is also a very realistic worry that some patients who request help in ending their lives may have conditions that can be improved with proper treatment, giving them a new perspective on life.
Among those conditions are severe pain and mental depression, potentially treatable problems that can lead to feelings of desperation.
Quill, a specialist in medicine and psychiatry at the University of Rochester School of Medicine and Dentistry, and a former director of a hospice center, put his career on the line two years ago by publishing in The New England Journal of Medicine his decision to supply a lethal dose of barbiturates to a terminally ill leukemia patient, who used them to kill herself.
The thousands of letters he received in response encouraged him to write a book, "Death and Dignity: Making Choices and Taking Charge," newly published by W.W. Norton ($21.95). In it he presents a case for a "cautious" exploration of doctor-assisted suicide "under carefully controlled conditions."
Last November, he and two collaborators, Dr. Christine Cassel of the University of Chicago and Dr. Diane Meier of Mount Sinai Medical School in New York, proposed these seven criteria for allowing doctor-assisted suicide in the New England journal:
1. The patient must have an incurable condition that causes severe, unrelenting suffering and must understand the prognosis and options of available care.
2. The patient must be assured of adequate "comfort care" so that a decision to die is not influenced by a fear or experience of suffering that can be relieved by less drastic action.
3. The request for doctor-assisted suicide must be made clearly and repeatedly and emanate from the patient's own free will rather than come from a family member or surrogate or even from a directive the patient prepared in advance of illness.
4. The patient's judgment must not be distorted by depression or some other reversible mental disorder which, if treated, might change the patient's perspective on a desire to die. For example, relief of depression in severely handicapped patients may allow them to see things that are worth living for.
5. The doctor involved should be one who has had a meaningful relationship with the patient and who can fully understand why the patient considers death to be the best option.
6. A consulting doctor should concur that "the patient's request is voluntary and rational, the diagnosis and prognosis accurate and the exploration of comfort-oriented alternatives thorough."
7. The patient, the doctor and the consultant must each sign a consent form attesting to the fact that the above conditions have been satisfied.
In an interview, Quill emphasized: "Each person has his or her own definition of what is tolerable. The patient is the expert on his own circumstances."
As he and his collaborators wrote in the journal, "The most frightening aspect of death for many is not physical pain but the prospect of losing control and independence and of dying in an undignified, unesthetic, absurd and existentially unacceptable condition."
This is how my mother died, and 35 years later I still regret that we did not let her choose her own way.
Jane Brody writes about health issues for The New York Times.