The International Anti-Euthanasia Task Force and its educational materials can now be accessed from an on-line computer anywhere in the world. The IAETF web site, located at http://www.iaetf.org, contains a wealth of up-to-date information on euthanasia, assisted suicide, health care advance directives, pain control, disability rights, and much more.
“With our web site up and running, it is so much easier for people to obtain the information they need,” said IAETF Executive Director Rita Marker. “When people reach our home page and all of the materials we currently have there, they can view or print out those materials, and even contact us directly by e-mail if they have questions or need additional information,” Marker added.
The home page offers people a wide range of options. By just clicking on those options, one can access, for example, answers to the most frequently asked questions regarding euthanasia and assisted suicide. Also listed are helpful IAETF factsheets on such subjects as advance directives, euthanasia practice in The Netherlands, the real Jack Kevorkian, and Oregon’s new assisted-suicide law. Other listed factsheets are currently “under construction.” Those include the facts on managed care and cost containment, statistics on death and dying, and the verbal engineering strategy behind the right-to-die movement.
The IAETF web site is ideal for any student or researcher delving into end-of-life issues. The On-Line Library contains original source material in one convenient place, saving hours of valuable research time. With a simple click of the mouse, actual laws and statutes, relevant court decisions, legal analyses, amicus briefs, and government hearings and reports — all dealing with euthanasia, suicide, and assisted suicide — can be accessed. The Helpful Links option provides resource information by topic. Those interested in finding out more about disability rights, government, law, current news stories, pain control, or hospice care can link to other sites dealing specifically with those areas.
The IAETF is also making its bi-monthly publication, IAETF Update, available on the web site. This is a valuable resource for anyone interested in keeping up with the rapidly occurring developments in the ongoing battle for the lives of vulnerable patients.
For those who have access to an on-line computer, welcome to www.iaetf.org.
Jack Kevorkian continues to carve his niche in infamy. In fact, emboldened by this year’s jury acquittals and with the help of a conspiratorial band of cohorts, Kevorkian has been instrumental in ending more lives than at any other time since he began his so-called “crusade.” But many in society are taking a closer look at this medical predator and at his victims, and seriously questioning the advisability of any policy change favoring assisted suicide.
Over a 2-month period starting in July, Kevorkian has been responsible for the deaths of nine people, bringing the total known body count to 40 (as of this writing). The man called Dr. Death and his lawyer, Geoffrey Fieger, have admitted, though, that there have been other deaths as well, all apparently Michigan residents, but those victims’ deaths have not been reported to the authorities. [New York Times, 9/7/96] Neither Kevorkian nor Fieger is revealing the exact number of unreported deaths, but Fieger did say that there were “more than one and less than 100.” [UPI, 9/9/96]
The nine people known to have died since the beginning of July are:
- Shirley Cline, 63, from Oceanside, CA; had cancer; died 7/5/96 by lethal injection.
- Rebecca Badger, 39, from Goleta, CA; no physical disease found, had depression; died 7/9/96 by lethal injection.
- Elizabeth Mercz, 59, from Cincinnati, OH; had ALS (Lou Gehrig’s disease); died 8/6/96 by lethal injection.
- Judith Curren, 42, from Pembroke, MA; no physical disease found, reportedly had chronic fatigue syndrome and depression; died 8/15/96 by lethal injection.
- Louise Siebens, 76, from McKinney, TX; had ALS; died 8/20/96 by lethal injection.
- Patricia Smith, 40, from Lee’s Summit, MO; had multiple sclerosis; died 8/22/96 by lethal injection.
- Pat DiGangi, 66, from New York; had multiple sclerosis; died 8/22/96 by lethal injection.
- Jack Leatherman, 73, from Knoxville, TN; had cancer; died 9/3/96 by lethal injection.
- Isabel Correa, 60, from Fresno, CA; had a spinal cord disorder; died 9/7/96 of carbon monoxide poisoning.
While all of the 40 known Kevorkian-assisted deaths have been tragic and unnecessary, two of the most recent ones have caused the greatest public alarm, even among some right-to-die supporters.
Rebecca “Robin” Badger, Kevorkian’s 33rd victim, was only 39 years-old. Twice divorced, a mother of two, and on public assistance, she had not had an easy life. Just days before she died, she told a California TV station that she wanted to die — that is, unless her excruciating pain could be controlled. [Jeff Wong, AP, 7/10/96] She had been diagnosed with “possible MS” in 1988 by one California doctor; another, family practitioner Dr. Johanna Meyer-Mitchell, said, “There never was any objective evidence as to why she was in as much pain as she said she was in.” Dr. Meyer-Mitchell, who treated Rebecca for 11 years, wrote in her medical records that there was “fairly minimal” evidence that she had multiple sclerosis. Doctors had noted that brain scans were inconclusive. However, the neurologist who had originally come up with the “possible MS” diagnoses, later changed it to an unqualified diagnosis, he said, only because of her seemingly progressive symptoms. She was using a wheelchair, had bowel and bladder dysfunction, and complained of acute pain.
Dr. Meyer-Mitchell had explicitly written a diagnosis of depression in Rebecca’s medical records, records which the doctor had sent to two Michigan physicians, not knowing that her patient was planning to enlist Kevorkian’s help to die. Rebecca herself had checked off “depression” and “confusion” as some of her problems on an 5/20/96 office visit form. But she refused to take anti-depressants, and, according to Dr. Meyer-Mitchell, was not pleased after a consultation with a psychiatrist. Rebecca had told her, “They think this is all in my head.” [Richard Leiby, “Just How Sick Was Rebecca Badger?” Washington Post, 7/29/96:A1]
As has become usual practice, Kevorkian attorney Geoffrey Fieger, described Rebecca’s condition at a press conference after her death. Saying that she had crippling multiple sclerosis, he added, “She had been suffering for years. She had a very malignant case.” [Jim Irwin, AP, 7/10/96]
But a subsequent autopsy was to prove otherwise. Oakland County Medical Examiner Dr. Ljubisa Dragovic found no signs of multiple sclerosis in Rebecca’s body. In fact, he said, “She doesn’t have any evidence of medical disease.” [Leiby, Washington Post, 7/29/96:A1] Dragovic also commented, “I think it shows how thorough their policy (assisted suicide) is. Someone gets depressed and says, ‘I have a disease,’ and they get an injection.” [UPI, 7/29/96]
Like Rebecca Badger, Judith Curren, Kevorkian’s 35th victim, was young. This registered nurse from Massachusetts was only 42 when she left her two small daughters, ages 7 and 9, to go to Michigan to die. She was accompanied by her psychiatrist husband. Reportedly, she had chronic fatigue syndrome (CFS) and a related, often painful, disorder called fibromyalgia. Neither is considered a terminal conditions. According to Geoffrey Fieger, though, she also had an immune deficiency which produced in her “funguses that attacked the brain and other AIDS-like symptoms.” [New York Times, 8/20/96]
But Fieger’s grim description of Judith’s “immune deficiency” had no basis in reality. Her autopsy, like Rebecca Badger’s, showed absolutely no evidence of physical disease, other than obesity. Medical Examiner Ljubisa Dragovic reported, “She did not have any signs of significant disease process.” “It raises serious concern,” he said, “because it shows a shallow approach, and no hesitation to do this type of termination without any evidence of serious disease condition.” But Fieger continued to insist that Judith’s death was justified. “I defy anybody with knowledge of her medical condition,” he said, “to say that she didn’t have the right to decide how much she had to suffer.” [Reuter, 8/19/96]
Dr. Edward Conley, director of the Fatigue Clinic of Michigan, does have “knowledge of her medical condition.” After pointing out that traces of CFS do not usually show up in autopsies, Dr. Conley explained that CFS patients can also have cognitive problems and that, in 90% of the cases, depression is experienced. “This is not a terminal illness,” he added. “Suicide is the only life-threatening part of this.” [Detroit News, 8/20/96] Reportedly, Judith began to consider suicide after reading Final Exit, Derek Humphry’s “how to” book on the subject. [Boston Globe, 8/18/96:A1]
There were other significant factors surrounding Judith’s death which were disturbing. Chemical analyses of her blood after autopsy revealed that she had been taking “hypnotic” drugs prior to her death which could have influenced her decision to seek out Kevorkian’s death service. Tests found that she was taking amphetamines, the depressants Xanax and Serax, and the narcotic Oxycodone before her 8/15/96 death. According to Boston University School of Medicine’s pharmacology department chairman, Dr. David Farb, “I wouldn’t want a person making a life or death decision with those three compounds in their system.” “Those three drugs in combination would almost certainly affect a person’s decision-making,” he said. [Detroit News, 8/30/96]
In addition, information surfaced regarding Judith’s troubled 10-year marriage to her former psychiatrist, Dr. Franklin Curren. Dr. Curren, a staff psychiatrist at Pembroke Psychiatric Hospital in Pembroke, MA, had been arrested just three weeks before her death on domestic assault and battery charges. According to court records, his wife claimed that he had manhandled her and that she was frightened of him. Dr. Curren acknowledged that they had argued that night, but said that the charges were her way of getting back at him for trying to talk her out of going to Kevorkian to die. He said that his wife suffered with depression and an obsessive disorder, and she refused to take her anti-depression medication. Then more information came to light. In 1993, police from at least two Massachusetts towns were called to the Curren home, and Judith had ended up taking out a restraining order against her husband. More recently, the Pembroke police had to be called to the Curren home nine times during last eight months of her life. [AP, 8/16/96; AP, 8/17/96; AP, 8/20/96; Detroit News, 8/30/96]
Dr. Curren, who owes $335,000 in back taxes, has been fired from his job at the psychiatric hospital and is currently being investigated by the state medical board for his role in his wife’s assisted suicide and for allegedly prescribing narcotics to her. [Boston Globe, 8/21/96:A1; 8/30/96:A16] Yet, he says, life after his wife’s death is “easier.” “The hard part was living with it, with all my wife’s problems.” [Oakland Press (MI), 9/1/96:A10]
Reaction, especially to the Curren death, has been strong. A Michigan poll released on 8/29/96 revealed that 52% of the voters think that Kevorkian was wrong to have helped her die. The poll conducted by the Lansing-based company, EPIC-MRA, found that 30% of the respondents said that the Curren death showed that Kevorkian was getting reckless and should be controlled; 22% said Kevorkian was always wrong in helping people die; 39% indicated support for the death doctor. [Reuter, 8/30/96]
Kevorkian responded to criticism surrounding Judith Curren’s death on Dateline NBC. He essentially told interviewer Chris Hansen that Judith’s domestic and drug abuse history were irrelevant. “I’m a medical doctor. I can review records, and I can see patients, and I can examine them. Who says I’ve got to learn what their family history is and who their children are and what they did 50 years ago? Who said I have to know that?” [Dateline NBC, 8/25/96]
Lots of people. Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, recently wrote, “There is no defense for what Kevorkian did. When he aided in the suicide of a despondent, abused and chronically disabled mother, he blew his carefully constructed moral cover. Kevorkian has shown he is willing to kill the despondent as well as the dying, the depressed as well as the doomed…. Think Jack Kevorkian is a hero? Ask Judith Curren’s children in a couple of years if they think so.” [
Oakland Tribune (CA), 9/3/96]
Even USA Today’s editorial staff, which has in the past supported Kevorkian, recently took the opposite position in their “Debate” piece entitled, “Our view: Kevorkian on the edge.” They wrote, “The fight can be lost by recklessness. Yet more and more, that is the charge Kevorkian invites…. Kevorkian says he counseled, as always, against suicide, but that his screening procedures found nothing to disqualify Curren, 42, from his services. Yet he didn’t know about the abuse charge, information that surely would have been germane.” [USA Today, 8/23/96]
George Annas, professor of health law at Boston University School of Medicine, said the Judith Curren case illustrates “the primary problem with the entire assisted suicide movement.” “It’s not that there aren’t some very persuasive, very alluring cases under certain circumstances, it’s that there’s no line that the law or ethics can draw, or that medicine can draw, which says which suicides are acceptable and which should be prevented. This one is a long way down the slippery slope.” [Boston Globe, 8/19/96]
It should be pointed out that the Badger and Curren cases were not the only Kevorkian deaths where the victim ended up having no physical disease upon autopsy. Marjorie Wantz, who was one of Kevorkian’s earliest victims, was also found disease free. She, too, had psychological problems. A jury found Kevorkian not guilty of her assisted death last May.
The next issue of the Update will cover Kevorkian’s new death team, which includes psychiatrist Dr. G. Reding; the latest on the unreported deaths; and a look at the legal and political situation in Michigan.
About the Known Victims
Of the 40 people who died with Kevorkian’s help…
- 40 (100%) were white
- 27 (68%) were female
- 11 (28%) suffered from illnesses that were diagnosed terminal
- 15 (38%) had cancer
- 8 (20%) had multiple sclerosis
- 7 (18%) had Lou Gehrig’s disease (ALS)
- 28 (70%) died from carbon monoxide poisoning
- 8 (20%) died of lethal injection(s)
- 4 (10%) cause of death uncertain
Married: 14 Single: 6 Divorced: 9 Widowed: 5 Uncertain: 6 Age: Under 40: 3 60-69: 8 40-49: 9 70-79: 9 50-59: 10 80& over: 1
Source (in part): Detroit Free Press, 8/23/96
Commentary: Controlling the fatal nudge. By Rita L. MarkerEach year there are more than 30,000 suicides in this country — more than the number of homicides. Yet now some would increase that number by offering “assistance” so that the despondent, the abandoned and the despairing — many of whom may have hesitated and turned back at the last minute — will get a helpful nudge into the grave.
Of course, those who advocate legalizing assisted suicide don’t see it this way. They say that some people need “help” since they’re physically or emotionally unable to do it alone. And they claim this help would be restricted to the most extreme cases, after all other options have been explored.
Sounds good. So does a sales pitch for vacation property that just happens to be smack in the middle of a swamp.
Those who might feel inclined to go for the attractively packaged deal — for what assisted suicide advocate Dr. Stanley Levy calls a “new age form of hospice care” — may want to consider a few questions.
If one must be “terminally ill” to qualify for assisted suicide, how is “terminal” defined? Will we say that the prediction by a doctor or two that one has six months left to live is sufficient? Then what about the 15% of people so diagnosed who go on to live much longer?
Or should we rely on the medical expertise of Jack Kevorkian, whose retirement from unemployment was interrupted when he became an expert in snuffing out the lives of people who could have lived for years? Kevorkian has defined “terminal” as “anything that shortens life by even one day.”
How about using suffering, not life expectancy, as the criteria? How would suffering be defined? As anyone who has experienced it can attest, intense emotional or mental suffering can be as excruciating as physical suffering. Should we then “go Dutch” and give society’s stamp of approval to “assisting” asymptomatic AIDS patients, anorexics, and people who are unhappy at being dependent on others for care? That’s what’s happening in The Netherlands.
We don’t need to look to The Netherlands, though, to see the face of assisted suicide. We need only look at two of Jack Kevorkian’s most recent victims, neither of whom had any physical illness at autopsy.
One was a California woman on public assistance, mistakenly diagnosed with multiple sclerosis. She had said she’d want to live if her pain could be controlled. Instead, her doctors sent her medical records to Kevorkian, and she became another statistic. Asked if her pain could have been treated, Kevorkian said, “Forget the pain. She couldn’t move very well either.” This from the man who wants to call his death van a mobile “mercy” clinic!
The other was a Massachusetts mother of two small children. Reports indicate that a major source of her suffering may have been that her husband (who transported her to Kevorkian for “treatment”) sometimes mistook her for a punching bag, even breaking her ribs eight years ago when she was pregnant. Asked about this, Kevorkian responded that he couldn’t be expected to know about what went on 900 miles away from his Michigan base of operation.
It’s safe to say that Kevorkian’s graveside manner leaves much to be desired. Even the most vocal euthanasia advocates like Betty Rollin and Dr. Timothy Quill are trying to distance themselves from him. They recently co-authored a New York Times opinion piece calling for guidelines that they said would stop Kevorkian and permit assisted suicide for the terminally ill under stringent controls. (Apparently Quill forgot that he himself has already written guidelines that would permit assisted suicide for people with multiple sclerosis and other “progressive illnesses.”)
Rollin and Quill also said that their plan for controlled assisted suicide would require that all options be explored before the coup de grace was administered.
What about that requirement? Do we really think people without medical insurance would receive hours of counseling and care before finding out death is the only affordable treatment?
And what about the insured? In many managed care programs, doctors receive cash bonuses for not treating sick patients. Should they be permitted to prescribe death?
Legalizing assisted suicide would not control Kevorkian or his slick imitations. It would only permit others to comfortably practice the ultimate form of medical cost containment.
Rita L. Marker is the executive director of the International Anti-Euthanasia Task Force and the author of Deadly Compassion – The Death of Ann Humphry and the Truth About Euthanasia.
Depressed people seek out negative feedbackClinically depressed people often prefer negative reinforcement rather than positive feedback according to a study published in the Journal of Abnormal Psychology. In fact, the depressed actively seek out negative feedback that confirms their own negative self views.
Dr. R. Brian Giesler, of Houston’s Baylor College of Medicine, and other researchers from the University of Texas in Austin, wrote that their data “suggest that by enacting self-verification strivings, depressed individuals may enmesh themselves in a self-perpetuating cycle that maintains or exacerbates their depressed state.” Previous studies have noted that when friends and relatives try to cheer up newly depressed persons by “denying or disconfirming their negative self-views,” the opposite effect can occur, with the depressed person demonstrating increased symptoms “to correct the misperceptions” of the friend or relative. As the condition deepens, the depressed person may simply withdraw from friends, relatives, and others who do not share or go along with the person’s negative self-view. The researchers suggest that cognitive therapy, which has been found to help depressed patients recover, can decrease “the certainty by which depressed individuals hold their negative self-views” and disrupt negative self-verification. [Griesler et al., “Self-Verification in Clinical Depression: The Desire for Negative Evaluation,” Journal of Abnormal Psychology, 8/96:358-368]
While this study does not address possible interactions between depression and a desire for assistance in committing suicide, the characteristic seeking out of negative feedback to support negative self views may explain why some depressed patients pursue right-to-die groups and individuals like Jack Kevorkian who reinforce patients’ negative views that their lives are intolerable and no longer have meaning.
According to a landmark study on American cancer patients’ views on euthanasia and assisted suicide, published this summer in Lancet, “Patients with depression and psychological distress were significantly more likely to have seriously discussed euthanasia, hoarded drugs, or read Final Exit.” [Lancet, 6/29/96:1805; see also Update, 5-6/96:4] Lead author of the Lancet study, Dr. Ezekiel Emanuel of the Dana-Farber Cancer Institute, commenting on a Kevorkian-assisted death, said, “It’s depression that’s the main motivator.” [The Boston Globe, 8/19/96]
Compassion in Dying v. Washington
The state of Washington has filed a petition with the U.S. Supreme Court to appeal the Ninth Circuit’s ruling in Compassion in Dying v. Washington State. On 3/6/96, the Ninth Circuit’s 11-judge en banc panel held that Washington’s anti-assisted suicide law violates a guaranteed “liberty interest in determining the time and manner of one’s own death” which, the court said, is contained in the U.S. Constitution’s 14th Amendment. [Compassion in Dying v. State of Washington, No. 94-35534, 1996 WL 94848 (9th Cir Mar 6, 1996) at 3; See also, Update, 1-3/96:1]
Washington’s petition argues that the Supreme Court should review this case because, if the Ninth Circuit decision is allowed to stand, it substantially redefines the “relationship between the federal judiciary and the States,” it creates “an expansive and intrusive role for the federal judiciary in reviewing State statutes,” and its finding (that there is a constitutionally-protected liberty interest to die) “conflicts with that of every other appellate court that has considered the issue.” [State of Washington v. Glucksberg et al., Petition for a Writ of Certiorari, July 3, 1996]
Amici curiae briefs in support of Washington’s appeal have also been filed with the Supreme Court. One such brief was filed jointly by 16 states along with Puerto Rico and American Samoa. Those states are California, Alabama, Colorado, Florida, Georgia, Iowa, Maryland, Michigan, Montana, Nebraska, New Hampshire, New York, South Carolina, South Dakota, Tennessee, and Virginia. This brief argues, among other things, that the sheer number of conflicts with other court rulings created by the Ninth Circuit decision is proof that the decision is completely out of line with “our Nation’s historical and traditional treatment of suicide and assisted suicide.” “In the history of our Nation, no court of final jurisdiction has ever declared the existence of a constitutional right or interest to commit suicide or assisted suicide.” [Brief of Amici Curiae States in Support of Petitioners State of Washington et al., State of Washington v. Glucksberg et al., No. 96-110, at 1, 3]
The American Medical Association (AMA) has also filed a brief asking the Supreme Court to hear the case and arguing that there is no constitutional right to physician-assisted suicide. The AMA’s brief was supported by the California Medical Association and the Society of Critical Care Medicine. According to AMA vice chair Thomas Reardon, M.D., “The time has come for the highest court in the land to make a declaration on the misguided and unethical practice of physician-assisted suicide.” [AMA press release, 8/22/96]
The Supreme Court is expected to decide whether to hear this case after the new term begins in October. If it agrees to take the case, oral arguments would likely be scheduled for early next year. The high court will also be deciding this fall whether to hear New York State’s appeal of the Second Circuit’s decision in Quill v. Vacco, which found two NY anti-assisted suicide laws unconstitutional — but for different reasons than the Ninth Circuit used in its ruling on Washington’s statute. (See Updates, 4/96:1, 5-6/96:1]
Please note: For future reference, the name of the Washington case, now that it has been appealed to the U.S. Supreme Court, has changed to: State of Washington v. Glucksberg et al.
Lee v. Oregon
On 7/9/96, a three-judge panel of the Ninth U.S. Circuit Court of Appeals heard oral arguments in Lee v. Oregon, the lawsuit challenging the constitutionality of Oregon’s new law permitting doctors to intentionally prescribe lethal drugs for the purpose of ending patients’ lives. A lower court judge, U.S. District Judge Michael Hogan, had barred the law, often referred to as Measure 16, from ever taking effect, ruling that the measure lacks adequate safeguards and denies terminally-ill patients the same protections against abuses which all other Oregonians possess under the state’s anti-assisted suicide law. The state of Oregon appealed Hogan’s ruling to the Ninth Circuit. (See Updates, 5-6/96:3, 9-10/95:1.)
During oral arguments, the Ninth Circuit 3-judge panel questioned whether the lower court should have allowed the case to proceed — whether the original plaintiffs (several terminally-ill or disabled patients, doctors, and nursing home operators) had standing to challenge Measure 16. The law requires that federal judges only consider real controversies, not theoretical ones. The Ninth Circuit panel asked plaintiffs’ attorney James Bopp whether Measure 16 poses a real or hypothetical threat of harm to his clients. Bopp responded that harm would be a “medical reality” since Measure 16 lacks sufficient safeguards and would expose depressed, terminally-ill patients to assisted suicide against their true wishes. Oregon Deputy Attorney General Thomas A. Balmer countered Bopp’s argument by saying that, even if Measure 16 has some flaws which put depressed patients at risk, those problem areas could be ironed out in the state legislature and should not be grounds for a constitutional challenge.
Bopp also argued that physicians who ethically oppose assisted suicide would also be harmed. While Measure 16 does allow doctors to refuse to assist in a patient’s induced death, informed consent laws would force doctors to tell patients that assisted suicide would be a medical option. Ninth Circuit Justice Melvin Brunetti retorted, “It sounds like you’re questioning the constitutionality of informed consent… informed consent is not part of this law.”
The Ninth Circuit panel gave no indication when it would issue a ruling in this case. [The Oregonian, 7/10/96:E3; The Columbian, 7/10/96:A3; Corvallis Gazette-Times Online, 7/9/96]
Kevorkian v. State of Michigan
Attorneys for Jack Kevorkian have filed a new petition with the U.S. Supreme Court asking the court to dissolve a 1991 permanent injunction barring Kevorkian from using any device to assist people to commit suicide. According to the petition, the permanent injunction “is overbroad, vague and amounts to a constitutionally repugnant prior restraint of free speech.” “The injunction must be struck down as being patently offensive to the Constitution of the United States,” the petition reads. “Surely, we have not come to the point where this Court will ever sanction a prior restraint upon any citizen for offering an act of kindness.” [Kevorkian v. State of Michigan, No. 96-135, Petition for Writ of Certiorari, 7/22/96, at 19, 23]
The petition is an obvious ploy to keep Kevorkian in the limelight if the U.S. Supreme Court decides to hear the Second and/or Ninth Circuit Court of Appeals right-to-die cases. “But for Dr. Kevorkian, this issue would not be being debated,” said Kevorkian lawyer Geoffrey Fieger. “I only think it’s appropriate now that Dr. Kevorkian be the first one before the Supreme Court and that we be allowed to argue our position to protect the rights of suffering patients,” he added. “We can’t wait another day.” [Reuter, 7/25/96]
The permanent injunction against Kevorkian using his homemade devices to end lives was issued on 2/5/91 by then Oakland County Circuit Court Judge Alice Gilbert. In her strongly-worded, even prophetic, opinion, Judge Gilbert wrote, “[Kevorkian’s] arrogance coupled with unabashed disregard and disrespect for his profession and its current professional and ethical standards reveal that his real goal is self-service rather than patient service. The reasons why Dr. Kevorkian has been unable to find employment in any accredited hospital are made patently clear to the Court. If allowed to continue with his death-delivering device he could well become an onerous burden, rather than a benevolent boon, to society.” [Michigan v. Jack Kevorkian, 90-390963-AZ, Cir. Ct. Oakland Co., Opinion, Feb. 5, 1991, at 32]
Judge Gilbert’s injunction, issued after Kevorkian’s first victim, Janet Adkins, died, has never been enforced. However, last April, the Michigan Supreme Court upheld the injunction after Kevorkian’s attorneys challenged it.
Related: Kevorkian has also filed lawsuits in federal district court (1) asking for injunctions prohibiting prosecutors in Oakland, Wayne, and Macomb counties from prosecuting him in the future and (2) asking that the Michigan Supreme Court ruling that assisted suicide is a common law felony be found unconstitutional. “We have to remove this final threat of prosecution,” Fieger said. “I don’t want it on the books anymore.” [Detroit News, 8/14/96; AP wire service, 8/14/96]
Rhode Island passes law to ban assisted suicideRhode Island has become the second state this year to pass a law banning assisted suicide. Earlier Iowa passed a similar law (see Update, 1-2/96:10). Rhode Island Governor Lincoln Almond announced that he supports the law which makes physician-assisted suicide a felony, punishable up to 10 years in prison. Gov. Almond said that Rhode Island wanted to avoid the kind of problems Michigan is now facing with Kevorkian. [American Medical News, 8/12/96:31]
Oregon Doctor accused of involuntary euthanasiaDr. James D. Gallant, of Corvallis, OR, has been accused by the state Board of Medical Examiners of ordering a lethal injection for a patient without her knowledge and against her will.
The patient, 78-year-old Clarietta Day, had suffered a usually fatal brain hemorrhage. After she was brought to the hospital, Day was given doses of two painkillers every 5 to 10 minutes over a 4-hour period, had a magnet placed over her pacemaker in an attempt to shut it down, and was taken off life support. According to the charges, Dr. Gallant ordered 100-milligrams of succinylcholine, a drug sometimes used to temporarily paralyze patients so that breathing tubes can be inserted. The nurse who actually injected the lethal dose is also being investigated and has agreed to stop treating patients while the investigation is conducted.
Day died 15 minutes after being given the lethal injection. Dr. Gallant signed her death certificate and listed the immediate cause of death as “stroke due to subarachnoid hemorrhage.” He claims that he “followed the wishes of the patient and the family.” The family says that it supports his decision. But Day had a health care advance directive. On or about August 10th of this year, she had added notes to the document indicating that, if she ever became unconscious, her life should be sustained for a period of 48 hours. That did not happen. The Board of Medical Examiners voted 10-0 to pursue disciplinary action against Dr. Gallant. [Corvallis Gazette-Times On-line, 7/21/96]
After years of reoccurring bouts of depression, Lester “Joe” Cruzan, father of Nancy Beth Cruzan, tragically committed suicide on August 17, 1996. The family’s lawyer, Kansas City attorney William Colby, said that Joe never recovered from his daughter’s 1983 car accident, which left her permanently brain damaged.
But Joe, 62, had earlier expressed concern and uncertainty over whether the right action had been taken after Nancy’s accident, action which resulted in her induced death seven years later. “I’ve wondered sometimes if we have finally accomplished for God what he set out to do,” Joe said in 1991. “People say that’s blasphemy, but I don’t mean it that way. I mean it as, ‘Where does God fit into the equation?'” [New York Times, 8/19/96]
Nancy had been the subject of a three and a half year landmark legal battle the family waged to have her food and fluids withheld. In May 1987 Joe and his wife, Joyce, began court proceedings to force the hospital staff caring for their daughter to stop her feeding and hydration. The Cruzans maintained that they just wanted to allow Nancy to die, since she would not want to continue living in her condition. They took legal action after months of consulting with the organization then called The Society for the Right to Die (formerly known as The Euthanasia Society of America; now operating under the name Choice in Dying).
While Nancy was left severely disabled and brain damaged from the accident, she was not comatose, nor was she on any life-support equipment. She could hear, see, and experience pain. There were times when she would smile at a funny story, cry when visitors would leave, and even try to form words. After the accident, court records indicate that she was eating mashed potatoes, bananas, eggs, and even link sausages, but a gastrostomy feeding tube was eventually inserted to make her long-term care easier for caregivers. She required no skilled nursing care and could have been cared for in a home environment. [Transcript, Cruzan v. Harmon & Lampkins, Case No. CV384-9P, Circuit Ct. of Jasper County, MO, 3/9/88-3/11/88]
In 1988, Jasper County Circuit Court Judge Charles E. Teel, Jr., issued a ruling directing the hospital to comply with the Cruzans’ request to withhold Nancy’s food and water. Later that same year, however, the Missouri State Supreme Court reversed the lower court ruling stating, “This is not a case in which we are asked to let someone die…. This is a case in which we are asked to allow the medical profession to make Nancy die by starvation and dehydration.” [Cruzan v. Harmon, 760 S.W.2nd 408, 412 (Mo. banc 1988), aff’d sub nom. Cruzan v. Director, Missouri Dept. of Health, 497 U.S. 261 (1990)]
The case eventually ended up before the U.S. Supreme Court. The question before the high court was the constitutionality of Missouri’s requirement that there be “clear and convincing evidence” concerning an incompetent patient’s wishes regarding medical treatment. The court ruled that the state requirement was indeed constitutional, and that, since there was no such clear and convincing evidence of Nancy’s wishes prior to her accident, her food and fluids could not be withheld. [Cruzan v. Director, Missouri Department of Health, 497 U.S. 261, 110 S.Ct. 2841 (1990)]
But the Cruzans, with the help of their right-to-die attorney, persisted. In August 1990, two months after the U.S. Supreme Court ruling, they once again went to court — this time with 3 witnesses they said could provide the needed “clear and convincing evidence” that Nancy would want to die rather than live in her disabled condition. Each of the witnesses testified that years earlier, during a casual conversation, Nancy had indicated that she would not want to live in a severely disabled state. On December 14, 1990, Jasper County Circuit Court Judge Charles E. Teel, Jr., the same judge who in 1988 ordered Nancy’s caregivers to withhold all food and water, did so again. [Cruzan v. Mouton, No. CV384-9P (Mo. Cir. Ct., Dec. 14, 1990)] Twelve days later, on December 26, 1990, Nancy Beth Cruzan died of dehydration. She was 33 years-old.
Minneapolis neurologist Ronald Cranford, a family friend and regular expert witness in favor of removing food and fluids in cases like Nancy’s, said Joe had been chronically depressed for some time. According to Cranford, Joe was “an ordinary man with extraordinary abilities.” “But he ran out of energy after [Nancy] died,” Cranford said. Commenting on Joe’s death by hanging, Cranford added that, in his opinion, Joe’s was “a rational suicide” since “he was never going to get better.” [American Medical News, 9/2/96:8]
Joe Cruzan was buried alongside Nancy in Carterville Cemetery. At the funeral, attorney William Colby commented, “I think he counted the final authorization of the court to set his daughter free as both his greatest and his saddest accomplishment in life.” [Kansas City Star, 8/18/96; Contra Costa Times, 8/20/96:1A]
PVS misdiagnoses common
A study reported in the British Medical Journal found that of 40 patients diagnosed as being in a persistent or permanent vegetative state (PVS), 17 (43%) were found to have been misdiagnosed by their referring physicians, 13 (33%) slowly came out of the vegetative state during rehabilitation therapy, and only 10 (25%) remained vegetative. The study also found that the incidence of misdiagnoses increased toward the end of the 3-year study period. In the first year (1992) there were two misdiagnosed patients, while in 1995 ten patients had been misdiagnosed by referring doctors.
All the patients had been referred to the Royal Hospital for Neurodisability, the only facility in Britain specializing in PVS. In most of the cases, the original misdiagnosis of PVS had been made by a neurologist, a neurosurgeon, or a physician rehabilitation specialist — all of whom would have had experience with the condition. Researchers concluded, “The vegetative state needs considerable skill to diagnose, requiring assessment over a period of time; diagnosis cannot be made, even by the most experienced clinician, from a bedside assessment.” [Andrews et al., “Misdiagnosis of the vegetative state,” British Medical Journal, 7/6/96]
The British study is one of the largest and most comprehensive investigations on PVS to date. Its findings are similar to an earlier U.S. study which found that, of the PVS patients who were referred to the Healthcare Rehabilitation Center in Austin, Texas, 38% were not vegetative at all and actually responded to stimuli upon subsequent examination. (See Update, 3-4/94:3.)
The British study’s lead researcher, Dr. Keith Andrews, a neurologist at London’s Royal Hospital for Neurodisability, wrote, “It is disturbing to think that some patients who were aware had for several years been considered to be, and treated as being, vegetative. It must be extremely distressing to be aware but unable to make contact with family or clinical carers.”
Andrews noted that all of the misdiagnosed patients were severely disabled; 65% were either blind or profoundly visually impaired. “Since demonstration of awareness needs a motor response, such profound physical disability complicates assessment of awareness,” Andrews wrote. “The very high prevalence of severe visual impairment, to the best of our knowledge not previously reported [by referring doctors], is an additional complicating factor since clinicians making the diagnosis of the vegetative state place great emphasis on the inability of the patient to visually track or blink to threat.”
Other study patients had significant motor impairments. One such patient had severe joint contractures requiring surgical release and physical therapy before he was able to sit properly. “Only when he was satisfactorily seated,” Andrews noted, “was it identified that he had a slight shoulder shrug which could be used for communication purposes.” All 17 misdiagnosed patients were found to range in cognitive ability from level 5 (aware but severely impaired) to level 8 (nearly normal) on the Rancho Los Amigos scale. [BMJ, 7/6/96]
In a BMJ editorial, Minneapolis neurologist Ronald Cranford pointed out that the quality of life of the 17 misdiagnosed patients was still questionable. “I would speculate,” Cranford wrote, “that most people would find this condition far more horrifying than the vegetative state itself, and some might think it an even stronger reason for stopping treatment” (i.e., food and fluids). But Dr. Andrews disagreed:
“This is a case of an able-bodied person making a judgment on what it is like to be in that condition. Human beings are survivors. Quality of life is something I have, not something you tell me I have. Some patients are distressed and I would not blame them. Some, sometimes after several years, seem to have come to terms with their condition. They go through a bereavement process about being disabled and it’s our job to help them through that. We have got to give patients an opportunity to live before we give them an opportunity to die.” [The London Times, 7/5/96]
U.S. doctors view PVS patients as “better off dead”
An American study published in the Annals of Internal Medicine found that physicians who care for patients diagnosed as being in PVS share common attitudes and beliefs concerning those patients. The survey of 319 U.S. doctors revealed that 89% believe that it is ethical to withhold artificial nutrition and hydration from PVS patients; 65% believe it ethical to harvest vital organs from these live patients for transplantation; and 20% think it ethical to give PVS patients lethal injections to hasten death. In addition, 13% believe that these patients have awareness and experience hunger and thirst; 30% say PVS patients feel pain. Less than 9% of the doctors responding think that PVS patients should be aggressively treated for respiratory failure, cardiogenic shock, acute renal failure, or cancer.
The researchers concluded:
“When evaluating the appropriateness of treatments for patients in the PVS, neurologists and medical directors largely concur. Most physicians in both groups believe that patients in the PVS would be better off dead; that it is not necessary to provide aggressive therapeutic interventions; and that all therapeutic interventions, including artificial nutrition and hydration, can be withheld in certain circumstances. These areas of consensus are remarkable and suggest that an ethical standard that physicians believe should be followed when caring for these patients may be emerging.” [Payne et al., “Physicians’ Attitudes about the Care of Patients in the Persistent Vegetative State: A National Survey,” Annals of Internal Medicine, 7/15/96:104]
One of the study’s most disturbing findings was that almost 50% of the physicians “agreed that patients in the PVS should be considered dead.” “Defining patients in the PVS as dead,” researchers said, “would eliminate the physicians’ responsibilities to these patients and thus may, in some respects, appeal to some physicians.” No longer would there be a need to debate the appropriateness of providing care if PVS patients were just “defined as dead.” Also U.S. law prohibiting organ harvesting from live patients would no longer be a problem for those who see PVS patients as a great source for vital organ donations. [p. 108]
Generally speaking, a vegetative state is considered “persistent” after 1 to 3 months. It is considered “permanent” if it lasts one year or more. We are told that the longer the patient remains in PVS — a condition where the patient is awake but not aware of self, others, or environment — the less chance there is for any improvement. Experts also say that most PVS patients do not get better. Yet this year alone individual patients both in the U.S. and abroad have broken through the neat medical categories and rendered more than a few experts answerless. Here are just three such patients:
- Early this year the case of an 18-year-old woman who returned to awareness after 15 months in PVS was reported in the New England Journal of Medicine. Dr. Nancy Childs, from the Healthcare Rehabilitation Center in Texas, described how her patient, who had suffered severe head injuries in a 1987 car accident, went from coma to PVS to interactive consciousness. When nurses noticed that the woman would sometimes do what they asked, like move her leg, her doctors started giving her drugs to improve her alertness. According to Dr. Childs, she eventually learned to answer multiple-choice questions, solve math problems, and even wrote a note to her mother saying, “Mom, I love you.” The woman now lives at home, is still disabled, but seems to enjoy life. Her case prompted Dr. Childs to propose that the term “permanent” be dropped from PVS. [New York Times, 1/4/96:A7]
- Then there was Gary Dockery, the Tennessee police officer who sustained brain damage from a gunshot wound to the forehead in 1988. While experts now question in hindsight whether Dockery was really in PVS for 7½ years, the fact remains that he was not expected to ever talk or regain consciousness, and his family and doctors were at the hopeless point of seriously considering letting him die of pneumonia rather than perform life-saving surgery. A few hours after two family members in Dockery’s room argued over whether to let him die, Dockery began talking and didn’t stop for 18 hours. During that time he joked, immediately recognized his sons (who had grown and changed considerably since Dockery’s injury), and reminisced with family and friends. When asked if he knew that he had not spoken in 7½ years, he answered, “Yes.” His doctor said that they will probably never know what caused him to come to at that time. His brother said, “He’s a lot more further along now than he was, and that gives us hope.” [San Francisco Chronicle, 4/8/96]
- In Britain, a former businessman in PVS for 7 years suddenly started appropriately communicating with the hospital staff last March. His case, according to experts, is truly remarkable. He suffered brain damage after an anesthetic accident during routine surgery. It is thought that in such cases — where the oxygen supply to the brain is cut off — the chance that the patient would be misdiagnosed as being in PVS is far less than with head injury. Sure that the patient was truly in PVS and would never improve, the British health authority had earlier considered petitioning the High Court to withhold all food and fluids from him causing his death, but his wife was adamantly opposed to the idea and indicated she would fight for his life. The health authority backed off. [The Guardian (London), 3/16/96.]
It appears that there are some in Britain who would agree with those U.S. doctors who think PVS patients’ lives lack value. Professor David Morton, head of the bioethics department at Birmingham University, recently told the Edinburgh International Science Festival that PVS patients, rather than animals, should be used in medical experimentation. According to Morton, PVS patients would provide “much more accurate information for experimets than chimpanzees.” Morton, an animal rights activist, said, “Twenty years ago society would not have taken seriously the idea of a person in a permanent vegetative state being used for experiments.” [The Daily Mail (UK), 4/8/96:6]
Australia’s euthanasia law may be overturnedDespite two failed local efforts to reverse Australia’s Northern Territory (NT) euthanasia law, the new law may be overturned by the federal government.
On 7/24/96, the NT Supreme Court ruled on a constitutional challenge to the euthanasia law brought by the head of the NT chapter of the Australian Medical Association, Dr. Chris Wake, and Aboriginal leader Rev. Djinilyinni Gondarra. In a 2 to 1 decision, the court ruled that the law, “Rights of the Terminally Ill Act,” is constitutionally valid and that the Territory does possess the power to enact such a law. Dr. Wake has indicated that he will appeal the decision to Australia’s High Court, and the federal AMA has urged all physicians and citizens opposed to the new law to contribute financially to a legal fund for that purpose. [The Australian, 7/25/96]
In August, an attempt to repeal the law in the NT Parliament also failed. After five hours of debate, the NT assembly voted 14 to 11 to defeat the “Right to Human Life Bill,” which had been introduced by euthanasia opponent Neil Bell. Bell said he was disappointed that his bill to repeal the new law had not passed, but indicated that the battle was far from over. [Reuter, 8/22/96]
The best chance by far for repeal rests with Australia’s national parliament. Three major party leaders have publicly voiced their support for “The Euthanasia Laws Bill,” which was introduced on 9/9/96 by Kevin Andrews. The bill would make it legally impermissible for Australia’s territories (NT, ACT and Norfolk Islands) to enact laws permitting euthanasia or assisted suicide. Australia’s federal government has constitutional power over territories, but not states. Euthanasia and assisted suicide are already illegal everywhere in Australia, except for the remote Northern Territory. NT Chief Minister Shane Stone staunchly opposes the bill, charging that the federal parliament is acting against the Northern Territory and undermining the rights of NT citizens.
Australian Prime Minister John Howard has strongly affirmed his support for the anti-euthanasia bill, saying that he has no problem reconciling his views on federalism with his views on life and death by voting to overturn the NT law. “The law allows a territory law to be over-ridden by the federal parliament, so we’re not acting unconstitutionally or improperly or indecently, we’re exercising the lawful power currently given to the national parliament,” he said. Howard also announced that he will allow a free conscience vote on the issue — meaning that parliament members will be allowed to vote their consciences free of party loyalties. This will be the first time in 22 years that a free vote has been allowed in Australia’s national parliament. The vote is expected in October. [Australian AP, 9/9/96; The Sydney Morning Herald, 9/10/96; Reuter, 9/9/96]
Doctors found age biased on DNR orders and health care provisionAccording to a recent study published in the Annals of Internal Medicine, doctors write more “Do Not Resuscitate” (DNR) orders for patients 75 or older, regardless of those patients’ prognoses or preferences. The study examined data collected on 6,802 seriously ill patients from five teaching hospitals in Massachusetts, Ohio, North Carolina, Wisconsin, and California. All the patients had been enrolled in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT) between 1989 and 1994 (see Update, 11-12/95:6).
Researchers found that doctors in the study relied on age to determine whether or not to use cardiopulmonary resuscitation (CPR) and used the age of 75 or older as the “threshold for limiting attempts at resuscitation.” This fact, according to the researchers, “suggests that physicians may be using age in a way that is inconsistent with the reported association between age and survival.” [Hakim et al., “Factors Associated with Do-Not-Resuscitate Orders: Patients’ Preferences, Prognoses, and Physicians’ Judgments,” Annals of Internal Medicine, 8/16/96:284, 291]
Dr. Joan M. Teno, of George Washington University Medical Center, said that this finding “is alarming to those of us who believe that medical decisions should be based on patient preferences and likely outcomes instead of age.” “Unfortunately,” she added, “it appears that physicians may be relying on age to indicate that less aggressive care is appropriate.” [Reuter, 8/15/96]
Another study reported on by the Associated Press supports Dr. Teno’s conclusion. The five-year study of 4,000 patients found that those over 80 years-old had surgery about half as often as similarly situated patients under 50. The study also revealed that an average of $7,500 less per patient is spent on those over 80 years. Researchers added that less care does not necessarily mean inferior care. They suggested that there is a possibility that younger patients are being overtreated. But Dr. Mary Beth Hamel, the study’s lead author and internist at Boston’s Beth Israel Hospital, told the Boston Globe, “[The study] does suggest a bias exists.” [AP, 9/7/96]