Dr. Jack Kevorkian's cropped image

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My student often with identify sincerity with truth, especially on matters of morality and/or religion. I remind them that Lenin was no doubt sincere in murdering hundreds of thousands of his political opponents. And he was sincere–unlike his successor Josef Stalin, Lenin really did believe in Communism and that killing people may be best for a greater good. Surely his sincerity does not make his actions morally right.

Dr. Jack Kevorkian was a sincere man. I do not believe, despite his rather expressive paintings of gruesome death scenes, that he was a psychopath or sociopath. He was well read in ancient Greek and Roman classics and was well aware that until Christianity came along, the vast majority of Greeks and Romans supported euthanasia–the Hippocratic Oath, based on the Pythagoreans’ high view of life, was the exception rather than the rule. Kevorkian used their arguments about a person dying with honor and dignity, arguments that were later revived by David Hume (1711-1776), to defend physician assisted suicide. Unlike the current Oregon and Washington State laws, which allow a physician to dispense a prescription of a deadly dose of drugs to terminally ill people who gave prior permission, Kevorkian went further. He built his infamous “suicide machine” which the patient could start himself, but Dr. Kevorkian had the set up in terms of inserting IV lines and arranging the correct drugs in each IV bag. The first bag released normal saline; the second a sedative to relax the patient; the third a dose of a deadly drug. Technically a patient could stop the process at any time; whether this always was the case in practice is a disputed point.

Dr. Kevorkian was not insane, but he was really, truly, sincerely wrong. He believed that he was easing the pain of terminally ill patients (although one woman he “assisted” had fibromyalgia, which is not a terminal illness). Error often contains partial truth, and the partial truth in Dr. Kevorkian’s stance is that a doctor’s sole duty involves more than preserving life. Sometimes it is best for a physician to allow the disease process take its course and withhold or withdraw burdensome treatment such as a ventilator or artificial nutrition and hydration. But to go beyond that and allow physicians to actively help a patient kill himself by a deadly drug that is in no sense a treatment for illness violates the fundamental end of medicine to “first, do no harm.” Kevorkian and his defenders might say, “But we euthanize animals who are hurting.” That is true, but animals do not have the level of understanding of the pain they feel compared to human beings. Human beings can understand what is going on and realize why they are in pain–and they can take steps to get medical treatment to stop the pain. Many physicians are not aware that most pain can be controlled with the proper drugs.

My best friend, during the final month of her life, was in hospice, where she received drugs to control pain and nausea. While the drugs were not by any means perfect, she did feel better, and I and her other friends were able to spend precious time with her and say goodbye before she peacefully passed away. If all terminally ill patients in pain received better palliative care, most of the clamor for physician assisted suicide would most likely go away.

Dr. Kevorkian represents the contemporary view that severe pain is the ultimate evil that can happen to a human being. Don’t get me wrong–I hate pain and have a very low pain threshold. I could not imagine the agony of being in constant, severe pain. I would want the best treatment for pain available if I were in severe intractable pain. In an earlier world that began to dissolve in the fourteenth century, pain was not considered to be the worst evil. Dying without salvation was. Today society is secular, and even many Christians are Christians in name only–they never accepted the world view and view of human nature that comes with Christianity. So they go back to the old Stoic view that suicide can be acceptable in some circumstances. Yet even the Stoics believed it was normally best to suffer misfortune and pain; suicide was a last resort to protect one’s honor and dignity. The modern world does not understand fortitude through pain, using illness to draw closer to the transcendent, or using a long, drawn out dying process to adequately prepare for death, both in secular and in spiritual matters. Today people want a quick death–in their sleep, of a sudden stroke or heart attack. There are times I feel that way, too, but when I use my reason, I realize that knowing one is dying, even if it involves great pain, gives one time to prepare, to say goodbye, and to draw closer to God. None of that would have made sense to the atheist Dr. Kevorkian. Yet a secular case can be made against PAS as well.

Not only does PAS violate the fundamental end of medicine, which is to help a person in need, doing no harm, but wide scale legalization would take away the psychological barrier to including more classes of people as candidates for PAS. Professor Margaret Battin once said at a talk I attended that she believed that someone with intractable chronic depression that could not be treated with drugs is a legitimate candidate for PAS. Most of the audience of physicians and philosophers seemed to agree. What about the person with chronic back pain that is not helped by drugs? What about the woman with fibromyalgia? To how many groups of people will PAS be extended.

In the Netherlands, where PAS is legal, thousands of patients have been actively killed by their doctors–without giving prior permission and without a family or friend as proxy giving prior permission. The doctor makes a judgment about the patient’s quality of life–and if the patient’s quality of life does not measure up to the physician’s standards, the physician kills the patient. A recent attempt to formalize a quality of life standard, below which a physician could kill a patient, was defeated in the Netherlands. But with some physicians already crossing that barrier, it may be just a matter of time before the law reflects practice.

Doctors already have a great deal of power over the patient. The patient comes to the doctor for help, and the doctor has the knowledge and the power to diagnose and treat the patient. Given that amount of power, would someone really want to agree with Dr. Kevorkian to give the physician the authority to help a patient kill himself? Once power crosses one barrier, historically it has tended to cross others.

Dr. Kevorkian meant well. But history shows that some of the worst tyrants in history “meant well.” Pol Pot really believed that by killing the educated classes and moving the rest of the urbanized population of Cambodia he could create a classless society. Instead he murdered over a million people. Dr. Kevorkian only was involved in helping a few hundred people kill themselves. But multiply that by hundreds of other Dr. Kevorkian’s along with a racially individualistic society that affirms that a person “has the right to determine the time and manner of one’s death.” Such hubris feeds Dr. Kevorkians and feeds physician power over life and death–and this in turn feeds Death itself. God help us.