USA Today, June 6, 2007

‘Dr. Death’ served us all with time in prison

by Sidney Wanzer

What has Jack Kevorkian, now that he has been released after eight years in prison for murder, actually accomplished?

In 1998, he openly dared Michigan to put him in prison for ending the life of a suffering person, and the state did just that. His detractors say he flouted the laws of our society and forced the state to punish him for his deeds. His supporters say he did all of us a service by pointing out what he thought was the right of a dying, suffering person to have autonomy over the manner and timing of death. In doing so, he brought this matter to the acute attention of the public in a way that no one had done before.

The latter is the important outcome. Kevorkian forced us to examine critically the need for new laws that will allow dying persons to end life in certain circumstances when this is the only truly compassionate treatment.

This need to actively end life is a very infrequent happening. The more common and proper sequence of events is that, as a fatal disease progresses, a point will come at which efforts to cure or restore some semblance of well-being are destined to fail.

The astute physician will help the patient and family recognize and define that critical point, so that a decision may be made properly to switch from curative efforts to comfort care only. This considered decision to redefine goals has the important effect of allowing the patient, family and physicians to stop expending emotional energy in fruitless directions and instead to concentrate on preparing for dying.

Comfort the dying

Comfort care becomes the only goal — to shepherd the patient through the dying process with as much calm and choice as is possible. This approach works because modern comfort care is now sophisticated and effective. It is possible to deliver meticulous attention to all the facets of pain relief and to prescribe symptomatic treatment for all forms of distress — physical and emotional — with a degree of efficiency that allows a reasonably comfortable death.

However — and this is a big however — there are occasional instances in which comfort care is applied with the greatest skill possible, and yet the patient continues to suffer intolerably in spite of all measures. This happens in the practicing lifetime of a physician only rarely, but it does happen. In my experience, these situations are self-evident. They cry out that physician-assisted death is the only humane and compassionate thing left in the spectrum of treatment at the end of life.

Where to draw line

Modern medicine is miraculous, but when its use extends the dying process inappropriately, it can be a disservice to the patient. When a patient actively invites death, it is not suicide, which most of us regard as an irrational act of a mentally ill person. Rather, it is the patient asking for treatment to end suffering by the use of a fatal dose of medication — an option that is legal only in Oregon.

Our country needs a law in every state, similar to that in Oregon, where almost 10 years of experience has shown that we can allow physicians to prescribe a lethal dose of a barbiturate for terminally ill patients who are suffering intolerably. In that state, there has been no abuse and no slippery slope that was so vociferously predicted.

From 1998 (when the law became operative) through 2006, only 292 patients utilized the law to end their lives in order to end suffering, after careful prerequisites. This number is tiny compared with the 85,755 Oregonians who died from the same diseases but without barbiturates.

Without fearing abuse, we should permit intolerably suffering patients the right to exert this ultimate autonomy in choosing the manner of their dying. Oregon and three countries in Europe allow this, but we all should have that option.

Doctors shouldn't have to go to jail for acting compassionately.

Sidney Wanzer, a physician, is co-author of To Die Well: Your Right to Comfort, Calm, and Choice in the Last Days of Life. Wanzer also is president of Compassion and Choices of Greater Boston, a chapter of a national right-to-die organization.

Posted at 12:15 AM/ET, June 06, 2007