EDITOR'S NOTE
Jack in a box

December 14, 1998

No matter where you stand on the issue of "assisted suicide," you have to hand it to Jack Kevorkian, MD. He has finally peeled the ethical question down to its core, and that’s bound to clean up the debate.

On Nov. 22, television’s "60 Minutes" showed Kevorkian killing a patient, Thomas Youk, an accountant and amateur race car driver who had amyotrophic lateral sclerosis (ALS). Kevorkian was seeking a showdown on Michigan’s new assisted suicide law, and after the footage aired, he was charged with first-degree premeditated murder and with assisting in a suicide.

Suddenly, the issue is clear: We’re way past assisted suicide. We’re into patient-requested homicide. But you won’t hear anyone calling it what it is. That’s because softening the language allows us to accept things that straight talk won’t.

Even watching the homicide on television hasn’t cleaned up the media’s use of words. A Nov. 30 Newsweek article on the topic said, "First, Jack Kevorkian filmed himself helping a 52-year-old-man to die ... " (the italics are mine). You’ve got to shudder when we start using words like "helping the man to die." Because it’s a very thin line between that and saying, "the robber then proceeded to help the clerk die." Or, the daughter of the woman with Alzheimer’s "helped her mother die."

The Newsweek article goes on to describe exactly how Kevorkian killed Youk. "This time, he did the honors himself," the article says. Makes it sound like offering a toast or carving a turkey, doesn’t it?

Now even proponents of assisted suicide are getting nervous. Barbara Coombs Lee of the Compassion in Dying Federation, in Oregon, was quoted as saying that having a physician actually administer fatal drugs opens the practice to abuses that cannot be controlled.

And those who spend their lives working with ALS patients have concerns, too. Mary Lyon, MN, RN, vice president of patient services for the ALS Association, in Calabasas Hills, Calif., says data shows only a very small number of patients have difficulty breathing or experience choking in the late stages of the disease. The mission of her organization—which takes no position on the assisted suicide issue—is to find a cure for ALS and to improve the quality of life of patients. She says many patients are getting relief and peace of mind from new approaches such as nasal ventilation, a noninvasive bi-level positive pressure breathing device that helps prevent shortness of breath and hypercapnea. Many ALS patients are also served well with hospice care, using palliative treatment, pain meds, and sedation. "There are other alternatives," Lyon said.

"We’re all going to die, and many of us don’t know how we will," Lyon said. She’s right. The terminally ill aren’t the only ones who worry about dying. So I wonder, should the fear of choking or of bleeding to death on a highway or of any other unappealing end permit others to kill me at my request? How sick—or old—do I have to be for the state to turn its head when someone kills me?

Of the 30,000 Americans with ALS, some will undoubtedly look to Kevorkian for inspiration. But it’s my hope that they’ll look instead to people like Stephen W. Hawking, an inspiring ALS patient and brilliant physicist—or to the nurses and others committed to helping them live with the fatal disease, and, when the time comes, to dying with dignity.

What do you think?

Barbara Bronson Gray, MN, RN
Editor in Chief

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