On November 4, the Beaver State became the Suicide State. Oregon voters reaffirmed a ballot measure on physician-assisted suicide (CT News, Dec. 8, 1997, p. 64). The last time they considered this issue, it squeaked by with a 2 percent margin, and a judge put the matter on hold. This time the spread was a solid 20 percent, and the court lifted the injunction.
Why did assisted suicide make sense to more voters this time? Perhaps because only the "useful" computes in our pragmatic age, and the value of life—especially one where there is suffering—is no longer self-evident. So why not be rational and end it?
What has really died is transcendence, the sense that undergirding our existence is a great, self-existent I AM who provides meaning, coherence, and direction to all that is. It is this religious sense that Michigan's infamous Dr. Jack Kevorkian considers the biggest obstacle to the rational adoption of assisted suicide. "Religious dogma has become part of the marrow of humanity. We can't get rid of it," he protests. "There should be absolutely no connection between medicine and religion, but there is, and it's paralyzing." Does he see no connection? "Going through medical school," he says, " … I knew euthanasia wasn't immoral, because my mind just wasn't encumbered with all this crap, you know?"
Suspicion that religion was contaminating medicine was also a factor in Oregon. The Catholic church, along with other pro-life Christians, fought the measure. The moral protest of religious groups was undermined by the pro-suicide forces, who broadcast scare ads, claiming the Catholic church was trying to control the lives of Oregonians.
When belief in God is gone, the claims of religion are interpreted as the mere exercise of power. Moral guidance from the church is no longer seen as standing for virtue or benevolent concern for the commonweal. Instead, it is routinely interpreted as the way the powerful oppress the powerless and limit their freedom. The language of civil and human rights is coopted by interest groups eager to secure their piece of the power pie. As Richard John Neuhaus has observed, today you only have rights worth respecting if you can assert them.
THE VALUE OF THE VULNERABLE
While proponents of assisted suicide say they are asserting their right to self-determination (which Dr. Kevorkian labels his "highest ethical principle"), they are actually endangering the vulnerable. Who is more vulnerable to the short-sighted vision of utilitarianism than someone who believes he or she has a degenerative disease, or who is discouraged by an inadequate response from the medical system, or who has not been formed by a community that strives for virtue and godliness, or who is coping alone?
Christians know the vulnerable are valuable because they mark a border that we must defend: for if we protect the vulnerable from the false compassion of those who would relieve our medical system of bearing their expense and purge the tax rolls of their care and the families of their burden and then cleanse the gene pool of their "pollution"—if we protect "the least of these" we have protected all, the greatest and strongest as well.
But the vulnerable are valuable in their own right. Our Lord would not break a "bruised reed" nor extinguish a "smoking wick." He is the one who "had no form nor comeliness that we should desire him." In identifying with the lowest, he who was highest demonstrated their ultimate value. Anything that endangers them should put his followers on alert.
Just how much does assisted suicide endanger the vulnerable? At this point, Oakland County, Michigan, is the main laboratory in which we can observe how it works. There, although the county attorney has assiduously prosecuted Dr. Kevorkian to the full extent of the law, juries and judges have given Dr. Death a relatively free hand. In that laboratory, we can see how patient vulnerability is exploited, and much-touted safeguards disregarded. Like other proponents of assisted suicide, Kevorkian has reassured the public by offering safeguards. But the Detroit Free Press has shown that he has violated his own guidelines with impunity. They report:
—Kevorkian says every assisted-suicide candidate must undergo extensive counseling with him. In fact, counseling is often limited to phone calls and brief meetings that include family members and friends.
—Kevorkian says every candidate must be examined by a psychiatrist. In fact, there was no psychiatric exam in at least 19 Kevorkian-assisted suicides.
—Kevorkian says patients who complain of chronic pain should be examined by a specialist in pain control. In fact, there have been at least 17 assisted suicides in which people complained of chronic pain, but Kevorkian did not refer them to a pain specialist.
—Kevorkian says he must make a detailed review of the patient's medical records. In fact, there have been some instances in which he received only a brief summary of the attending physician's prognosis.
—Kevorkian says candidates should be suffering from an incurable affliction or one that cannot be treated without intolerable side effects. In fact, autopsies of three Kevorkicides revealed no anatomical evidence of disease.
—Kevorkian says at least 24 hours should elapse between a patient's final request and death. In fact, at least 19 patients died less than 24 hours after meeting Kevorkian for the very first time.
These reports show that a utilitarian mindset can rationalize any exception to principled safeguards. Such guidelines prove to be mere window dressing for the benefit of those at a distance. Those who become involved in assisted suicide discover a different reality. As Oakland County undertaker-poet Thomas Lynch opines in his new book The Undertaking: "Where abortion is available on demand, should we really expect to moderate or regulate assisted suicide?"
ABANDONED BY THE MEDICAL SYSTEM
The Free Press reports show something else: that through our present medical system, we do not adequately care for the vulnerable. In many of the Kevorkian cases, assisted suicide was chosen by people with treatable conditions who were bounced from specialist to specialist without coordinated care: people with chronic illnesses who were not given adequate guidance and aid in coping; people whose pain was not taken seriously; people whose mental-health issues were ignored by those who treated their bodies; and in a few cases, people who were simply misdiagnosed. Several patients said Kevorkian was the first doctor who ever listened to them. These people were not driven to Kevorkian because they were sick; they sought him out because they were set adrift, and he was willing to talk to them and offer them a plan.
Concern for the vulnerable must not stop at opposing assisted-suicide legislation. It must also work for renewal (dare we say revival?) of the patient-centered care that characterized both the Hippocratic and the Christian medical traditions. It must work to preserve medical services in our urban centers, where hospital closings by distant corporate owners are becoming all too frequent. Ultimately, this is a question in which the values of the marketplace are undermining human and divine values. Hospitals will close, doctors will provide minimal care, patients with terminal diseases will be shunned and shunted off, all because the marketplace knows only utility. "Unvexed by the existentials," writes Lynch, "should we not expect the marketplace to take over? The questions devolve from whether or not to who is entitled to who's going to pay to cash or charge? to do you take American Express?"
We need a revolution in values—a revolution that cannot be raised without the conversion of many hearts and the care of many loving hands.
The Detroit Free Press book reporting on Dr. Jack Kevorkian is available from the Free Press, 321 W. Lafayette Blvd., Detroit, Mich, 48226.
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