Monday, June 13, 2011

The Right To Live And The Right To Die

A few months ago I watched, “You Don’t Know Jack,” the movie where Al Pacino plays Jack Kevorkian, or the man known as “Doctor Death.”

And it got me to thinking.  In the movie, Kevorkian blames doctors for selfishly keeping people alive who have no quality of life.  That’s very subjective.  I’m sure that on my worst days, somebody would think my quality of life is pretty bad.  But at least for me, right now, my quality of life is relatively good, all things considered.  I’m not planning on jumping ship any time soon. 

But what about some of the patients Kevorkian assisted in suicide?  Some had Lou
Gehrig’s Disease, Multiple Sclerosis, and debilitating and incurable cancers, among others.   

People asked to die.  Some had attempted to take their own lives, but had been unsuccessful.  They sought Kevorkian out, not the other way around.    

What if, when everyone turns 18, they are handed a pill, a suicide pill, like what they give to astronauts and some politicians, in case they get stuck in space or are captured by the enemy (at least in the movies).  We would all have one, riding around in our back pockets, a symbol of knowing that we have a choice.  That there is an out if we want one. 

Hospitals offer up advanced directives, DNRs, and power of attorney. 

And that’s okay. 

I’ve certainly been asked if I wanted additional information about them during my two hospital stays.  And it irked me.  On one hand, I thought maybe things were worse than I was being told.  On the other, I felt like giving in to such things at such a young age would simply make it a reality that I would die young (or maybe it’s my past obsessions with people who have died young, like Evita and Selena, that make me feel that way).

In theory, we are supposed to make choices for ourselves.  And we would like to think that if and when the time comes, those choices will be carried out.

While on the surface it may seem that Kevorkian is an enemy of modern medicine, the movie paints him as a sympathetic character.  Someone who truly believes in what he is doing, and this is only furthered in the portrayal of ill patients who genuinely wanted to escape their constant and unending pain.  These people wanted to make the decision while they were capable of doing it on their own, and so they did. 

Obviously, that’s not an option in all cases, as in, for instance, when someone ends up in a persistent vegetative state.  At that point, that’s where things get really dicey, and this has been played out in the media at various times. 

So I wonder.  If we were given an out, the ability to say exactly when and where the end will come, would we use it at a desperate moment, possibly in a situation that would ultimately resolve itself?

You know, I don’t think so.  The human spirit is pretty resilient.

But then again, I’m unsure.  In a post I wrote several weeks ago, I talked about prednisone as an out for the pain I was in.  But if I had a cyanide pill, at that moment, when I felt like the world was crumbling down around me, would I just have assumed end things right then and there? 

It’s a scary thought.  But shouldn’t we be the ones who define the end of our world, as we know it?  If astronauts and politicians have an escape clause, why don’t the rest of us? 

I’m not saying that I’m an advocate for suicide.  But I’ve been in pain, pain so bad that I would have given anything for it to end. 

And I think this argument transcends political and religious beliefs.  It gets at something deeper. 

In the movie “Wit,” which I also saw recently – and wouldn’t recommend for anyone who is ill – Emma Thompson has stage 4 ovarian cancer.  She is DNR.  At one point, the resident said that they never expected her to live through all eight experimental chemotherapy treatments.  When she codes, the resident ignores the DNR order, in an effort ultimately to prove that it was the cancer, and not the ridiculous chemotherapy treatments they were giving her, that kill her.  

The point here is that DNR is subjective, and not necessarily always heeded.  So if you can’t rely on that to get your wishes across, what or who can you rely on?   To me the answer to this question is obvious.  You can only really rely on yourself.  Which brings us back to the argument about a suicide pill.   The point of it, aside from what it does, is the power and control it gives to the person who has it in their possession. 

You say when.  You say where.     

I’ve been working on this post for awhile, so it’s a little weird that Jack Kevorkian died in the middle of my writing it.  Some say that he was down to about 70 pounds when he died.  There are rumors of kidney disease, Hepatitis C, and liver cancer.  He was an allusive character.  But in some ways, I think he was ahead of his time.  After all, he did get his MD degree from the University of Michigan, the very school I go to, that espouses itself as the home of “The leaders and the best”.  

Obviously, I wasn’t present (or necessarily even born) to be able to comment on his methods, the times that his rudimentary inventions didn’t work as planned, or much of the controversy surrounding his life. 

In doing some digging, I found that Kurt Vonnegut wrote a book in which he has a series of “controlled” near-death experiences, where Kevorkian helps him meet people in the afterlife, but then he returns to earth.  The story takes place in the lethal injection room of a prison in Texas.  Oddly enough, the book is called “G-d Bless You, Dr. Kevorkian” (1999).  Were the two really friends?  I guess we’ll never know.  But in Vonnegut’s imagination, he has all of these interesting experiences until Kevorkian is arrested for murder.  Apparently Vonnegut was a fan of Kevorkian’s.  Why else would he have written such a laudatory book about him? 

And there’s tons of irony here.  Vonnegut turns the man known as Dr. Death into a hero, saving his life over and over again.   But maybe this odd display by Vonnegut tells us something more important about the legacy of Kevorkian.  Maybe he was a hero, by allowing people who no longer wanted to live the chance to escape.  There weren’t any do-overs for them, though, and there certainly aren’t any for him.  Maybe by granting people death on their own terms, he actually saved them from lives that would have been full of pain and misery.  I don’t know.  I can’t ask Kevorkian and I can’t ask the people he helped to die.  And I think that’s what makes this such a touchy subject.  There is so much that is unknown, and that we will never know, about him and about them.  

Is it ironic that Kevorkian had a “natural” death in a hospital.  Maybe, maybe not.  I think the real question is: was that his choice?  Was that what he wanted in the end?  Because if it was, then he stayed true to his mission.  If not, well, he should have gotten a better attorney to see that his rights were carried out. 

In many ways, it’s surprising to me that he went quietly.  I always assumed that his end would come with some of the bravado that surrounded his life. 

But if there’s one thing that Kevorkian brought out with great relief, it’s that modern medicine doesn’t have all the answers.  Doctors play g-d all the time.  I think it’s time that we played g-d a little bit, too, at least in our own lives (and deaths). 

Currently in Britain, author Terry Pratchett, who has Alzheimer’s disease, is currently fighting for his right to die, suggesting a take-home “suicide kit”, allowing terminally ill people to end their own lives.  He also hopes that his death will be broadcast on British television.

This example suggests that the death of Kevorkian does not mark the end of the discussion about the merits and drawbacks of physician-assisted suicide.  To the contrary, it seems to me that the conversation is only just beginning. 


  1. I'm left a little bit speechless by not having heard about Terry Pratchett's alzheimer's disease diagnosis. Wow.

    Oregon has its assisted suicide law, the Death With Dignity Act, that, under certain circumstances, allows people to get prescriptions to end their lives at home.

    I, um, had stuff to say until I got to the part about Pratchett, and I'll try to come back when I can organize my thoughts again. :)

  2. Don't have time to dig my references, but there is actually a body of research that shows that a lot of suicides are a question of impulse and having easy means. Therefore doing things like inaccessible railings on bridges brings the suicide rate down. People do reconsider. I certainly would not want to have an "instant suicide" pill, for that reason (even though I am not at all suicidal, nor ever considered yet).

    That said, someone close to me died from incurable cancer. The last couple of weeks were brutal on him, on me, and on the entire family. We were all so helpless, someone actually asked one night, "what if the doctors just gave him a much bigger dose of morphine, seeing as they cannot stop his pain now?" And no, we never did anything, we just watched the suffering helplessly to the end. There was no hope there, only pain for everyone involved. This was before there were DNR orders or laws governing this kind of thing. Still painful to think about this...

  3. A thought provoking post indeed. I think what irks me most about ra is the lack of pain treatment being provided to its sufferers. You even mentioned your unrelenting pain and it is at these moments that cutting oneself free from it becomes paramount. Our medical community here needs to start treating the pain of ra with same respect cancer patients get for the pain they suffer. We are no less and no more and it is high time we are treated with the respect we so rightly deserve. Constant, debilitating pain is something no human should have to endure on a day in and day out basis.

  4. Thought provoking and thoughtful post.

    I think one of the biggest issues regarding assisted suicide is our culture's discomfort with death. We really handle it badly on so many levels, which is crazy because it is where we all end up in the long run. (We screw up birth too, but that is a whole different topic.)

    Another problem is that many suicides are related to depression and are theoretically preventable.

    These two things create a double whammy when it comes to accepting a rational, reasoned decision to end an intolerable existence related to a physical condition.

    It is definitely a topic we need more balanced and dispassionate discussion about.