Tuesday, May 29, 2007

The Kevorkian Effect

To some, Dr. Jack Kevorkian is a hero, and to others he is a villain. But, no one can dispute that he brought the issues of end-of-life care and physician-assisted suicide into public debate.

According to this article from the Associated Press, he will be released from prison on June 1st after serving more than eight years of a 10-25 year sentence for the death of a Michigan man.
He used a machine he'd invented to administer fatal drugs and dropped off bodies at hospital emergency rooms or coroner's offices, or left them to be discovered in the motel rooms where he often met those who wanted his help.

At the time, some doctors didn't want to give dying patients too much pain medication, fearing they'd be accused of hastening death.
Kevorkian said that he would be happy to go to jail for his beliefs. But, what effect has he really had in the area of physician-assisted suicide? Up to this day, only one state, Oregon, has a law allowing physician assisted suicide.
Experts say that's because abortion opponents, Catholic leaders, advocates for the disabled and often doctors have fought the efforts of other states to follow the lead of Oregon, where the law took effect in late 1997.

Opponents defeated a measure in Vermont this year and are fighting similar efforts in California. Bills have failed in recent years in Hawaii, Wisconsin and Washington state, and ballot measures were defeated earlier by voters in Washington, California, Michigan and Maine.
I remember having pretty heated debates in my medical ethics classes while in college in the early 1990's. "Kevorkian" not only was a name, but also used as a verb - both positively and negatively - depending on which side of the debate you were on. Back then, predictions were made that a majority of the states would eventually have physician-assisted suicide laws.

As one looks back over the past 10 years or so, you have to ask yourself this question: What was the real effect of Jack Kevorkian? Personally, I think he did raise awareness of end-of-life issues - although in kind of shocking way.

But, did he really influence public policy? I guess that will be debatable for a long time. Some will say he is a failure because only one state has physician-assisted suicide legislation. Others will say that he indirectly influenced other legislation having do with end-of-life issues. We'll have to see how history ultimately judges Dr. Jack Kevorkian.


Anonymous said...

That is a tough question...honestly, I think regarding this issue, we are much more humane to animals than to humans, but that regarding the sacredness of human life, raises all of the ethical concerns... however QUALITY of life should also always be considered! Making a patient's life more tolerable throughout treatment of whatever illness, and responding to individual patient needs and goals, should be definitely more considered, even if that includes the possibility of a speedier death. Medications to relieve symptoms should always be an option for a patient. We often force lengthier lives on people with interventions, which don't necessarily enhance the QUALITY of life, and at that point I truly believe we are creating that ethical dillemna to be huger than it ever would have been...
If comfort meds speed up death, that should be patient and patient family choice. Maybe having a patient care advocate in place could help to discern more if the decision was made rationally.

Dr. K did alleviate the suffering of many individuals....I have to say, that though I don't know yet about the full scope of his practice, there are definitely instances which he should receive much credit for.

Anonymous said...

There are just times when we have to accept that death is inevitable. I'm all for alleviating pain for patients, especially those who are terminally-ill. Administering pain medications do have the risk of hastening death but it should be explained to the patient and the patient's loved ones.

In our country, what we do in cases of terminally-ill patients, we explain the critical condition of the patient to the relatives and then ask them (most of the time the patient is already not able to make his wishes known)if they still want us to resuscitate the patient if time comes that the patient will go into cardiac-arrest. After thorough discussion, the relatives will have to outline which medications they only want to give to the patient when that time comes. Usually the list ends up only with pain medications and other medications used to alleviate symptoms, but no resuscitative drugs or procedures to be done. At least, this way, everything is clear even from the start.

As for Dr. Kevorkian, I don't think his methods are quite right, although he may have good intentions. This issue is yet to be settled.

breadchick said...

Dr A, this really hits home tonight. As I sit here typing this, we are waiting for MBH's father to die in hospice(kidney failure due to complications and infections of mulitple strokes). We are in the 4th day of the long wait (MBH's father had a living will, end of life issues discussed with family) and have been told it should be "soon". I am glad that he will soon be released from his suffering but did this have to be so agonizing for him, for us? We treat our pets better than we treat our family members at this time of life. If MBH's father had been the family beagle, we would have been given the time needed to say goodbye and our beloved pet's suffering would be over. Instead, we are left to watch the life ooze from this dear man's life. For a country where I am forced to look at bumperstickers screaming "Right to Life" I am also forced to watch death with no dignity. Dr. K may have been in the extreme at the time but he and Oregon are right.

KC Saul said...

It's a shame that Dr. Kevorkian would be the face associated with assisted suicide. Whatever you think of assisted suicide, Dr. Kevorkian is nothing more than a serial killer with an M.D. His victims include persons who were far from terminally or incurably ill. He hid behind the lie that he was euthanizing suffering patients at their own request. There are patients who are suffering who may wish for a doctor to assist them, and that is a matter for another debate entirely. But Dr. Kevorkian's actions had nothing to do with that, despite what he said. The actual facts and case histories of his victims would be useful for illustration, and are easily found.

Anonymous said...

Quality of life has zero to do with what you can physically accomplish. It has everything to do with how much you are able to give and receive love. The end of life is a time that can bring great healing and a lifetime of comfort between a patient and those around them--or not. When people get upset that their loved ones are suffering, what they don't realize is that what they're really upset about is that *they're* suffering, having to watch it happen. They're empathetic, and caring, and mean the best, but they don't have the blessing of having to directly and personally experience the failures of the body in the process, where there's this sense of great triumph simply in being alive the next day, still with your loved ones, no matter how crummy you feel.

I write this as someone who was once dying in a hospital bed--and my doctor walked in in the middle. I looked up at that kind, deeply compassionate man, and knew that he would blame himself for the rest of his life if I didn't make it. I couldn't do that to him. I had to pull through. Breathing through that night was the hardest thing I have ever done, but I did it. Because I was loved, not only by my family, but by someone whose needs transcended my own to me in those particular circumstances--because that good man loved a patient he didn't even know well.

And THAT is quality of life.

Anonymous said...

MS Hospice Chaplain
Here we don't need a Dr. Jack we just ask the attending Doc on call for more pain meds and keep administering them to "ease the pain." This basically hurries up the process and therefore we have a more timely end when the family is in town to do the service etc. Everybody gets tired of draging out a comotose patient. I strongly suspect this happens in the still calm of the middle of the night between the minister and the doc and a nurse in many places across the world. It just isn't advertised like Jack or Oregon. Dr. V.