Killing to be kind?

The judges of the Michigan Court of Appeals deserve to be applauded for, on 21 November 2001, rejecting Jack Kevorkian’s appeal to regain his freedom and thus the opportunity to resume his career as a medical killer (1).

Let us not forget that Kevorkian broke, and broke again, not only the law but also his word. During his killing spree, he posed as a medical saviour and promised to starve himself to death if sent to prison. ‘I know they are going to force-feed me’, he declared, ‘and I’m not going to go along with it’. It never came to that. Kevorkian is feeding himself.

At his 1999 trial, which ended in his being found guilty, Kevorkian insisted on representing himself. In his appeal, he claimed he had ‘inadequate legal representation’. What gall.

He also claimed that the lethal 1998 injection of Thomas Youk – a performance he filmed and sent to 60 Minutes to advertise his services – was a form of euthanasia. At one of his trials that ended in acquittal, Kevorkian was asked: ‘Have you ever wanted a patient to die?’ Under oath, Kevorkian replied: ‘Never.’ Euthanasia is defined as the providing of a merciful and painless death. If Kevorkian didn’t want his ‘patient’ to die, what did he want him to do? Survive a botched physician-assisted suicide?

Kevorkian remains important largely because many people in America and the US media see him as martyr to the cause of physician-assisted suicide: he helped suffering patients end their lives. This is an utterly false image. Webster’s Dictionary defines suicide as ‘an act or an instance of taking one’s own life voluntarily and intentionally’.

Strictly speaking, assisted suicide is an oxymoron. This does not mean, however, that some people may not help others kill themselves by furnishing the means to do so, for example, by selling them a car or a gun. We do not regard car dealers and gun dealers as practicing suicide assistance, and do not call killing oneself by means of these tools ‘assisted suicide’.

Similarly, we do not regard physicians or pharmacists who kill themselves with drugs, to which they have privileged access, as committing ‘pharmaceutical company-assisted suicide’. Yet, we regard persons who lack legal access to lethal drugs but kill themselves with such drugs made available to them by doctors as having committed ‘physician-assisted suicide’. We confuse medical bootlegging with medical treatment.

To understand why anybody who loves liberty under law, and loathes medical paternalism, ought to oppose physician-assisted suicide, we must ask and answer the question: why do people need the help of doctors to kill themselves with drugs? The answer is obvious: because the trade in drugs useful for killing oneself is illegal and anybody interested in terminating his or her own life with a drug needs a doctor to supply it.

Misleadingly, Kevorkian’s subjects were called ‘patients’. But Kevorkian had no licence to practice medicine, and the people he ‘helped’ did not come to him to be diagnosed or treated. They came to be killed and often travelled long distances to secure his services. If they could do that, they could have killed themselves by other means. They came to Kevorkian, then, either to obtain lethal drugs to which they had no access but Kevorkian did, albeit illegally; or they came to die by Kevorkian’s hands rather than their own, anxious to depict medical killing as ‘therapy’.

Kevorkian was eager to oblige, portraying himself as a heroic fighter for a right to suicide. In his book, Prescription: Medicide, Kevorkian stated that ‘helping suffering or doomed persons to kill themselves…is merely…a distasteful professional obligation…. What I find most satisfying is the prospect of making possible the performance of invaluable experiments or other beneficial acts’ (2).

To the press and the public, Kevorkian represented his activities as a medical obligation, imposed on him by his conscience and medical degree. To make himself appear a medical saviour, he falsely diagnosed his ‘patients’ as dying. Eventually, his conceit got the better of him, and he was sent to prison, where he belongs.

‘Liberty’, declared Lord Acton, ‘is the prevention of control by others’. Either the state controls the means for suicide and thus deprives persons of a fundamental right to self-determination, or the individual controls it and assumes responsibility for the manner of his or her own death. Kevorkian urges us to delegate responsibility for suicide to physicians, promising benefits to those who ‘need’ it. However, since need is defined by the doctor, not the patient, the result is enhancing the prestige and power of physicians, and diminishing the autonomy of individuals, often at precisely that moment in their lives when that is all they have left.

Thomas Szasz MD is emeritus professor of psychiatry at the State University of New York, Upstate Medical University, in Syracuse, and author of Fatal Freedom: The Ethics and Politics of Suicide, Praeger, 1999. Buy this book from Amazon (USA) or Amazon (UK).