Tag: Dr. Death


Review of Book About the Death-With-Dignity Movement

September 5th, 2012 — 2:37pm

Faced with my mother’s decision to end her life after suffering from Parkinson’s disease for many years, I spent the last year of her life wrestling with how to respond. Because her doctors were unwilling to help her – and because assisted suicide is illegal in my hometown (Washington D.C.) — my mother decided to stop eating and drinking, believing it would pose less of a legal risk to my sisters and me. Despite the near total cessation of food and liquid, she lived for close to two weeks and would have lived longer if she hadn’t taken an overdose of morphine several nights before she died in order to speed things along.

Although I did not initially embrace her decision to end her life, I was angry and distressed at how hard it was for her to accomplish her “good death” and, in the years since, I have become deeply convinced that choosing when and how you die is a basic civil right. In his cogent, detailed chronicle of the modern right-to-die movement, In Search of Gentle Death: The Fight for Your Right to Die With Dignity, social historian and author, Richard N. Cote, makes this argument in eloquent, quietly reasoned prose.

In a passage that I found deeply resonant, he writes: “Only the suffering person is capable of determining how much agony is endurable and deciding that the choice of a peaceful, painless death is preferable. The death-with-dignity movement declares that it is an individual’s right to decide whether or not to continue living, not the privilege of someone else to require that he or she must live.”

Upfront about his admiration for the movement and its leaders, Cote assumes a corresponding sympathy in his readers and I was initially distracted by the book’s “preaching to the choir” perspective. But once Cote gets into his story, he spends little time editorializing and is never shrill or polemic. And for a book about illness, death and the hard choices they command, I found the book surprisingly entertaining. With a novelist’s eye for detail, Cote skillfully brings a wide and colorful cast of characters vividly to life, introducing us to the many activists and patients who have shaped the modern right-to-die movement.

Started in the 1930s by a small group of intellectual philosophers, the death-with-dignity movement has evolved into a vast, international civil rights movement. The titans of that movement — Derek Humphry and Jack Kavorkian – are given top billing (appropriately enough), but Cotes also includes a number of less familiar figure including his friend, George Exoo, a liberal Unitarian minister who worked as an “exit guide” and found himself facing a 14-year prison term after helping an Irish woman, Rosemary Toole, to die. Many others, including Dr. Soichiro Iwao of Japan, Ludwig Minelli of Switzerland, Dr. Gustavo Alfonso Quintana of Columbia and Marilyn Seguin of Canada are shown putting their personal and professional lives on the line in the service of their beliefs.

But for me the most powerful stories were those of the patients who were willing to travel, testify and make themselves into “case studies” to help win the legal right to end their lives peacefully and on their own terms. There was Sue Rodriguez, an athletic woman struck down with ALS at forty-one, who was willing to be the “poster child” for the right to die in Canada and whose court case changed the way Canadians view the issue. (Her words, “If I cannot give the consent to my own death, then whose body is this? Who owns my life?” were a haunting challenge to those who would make such an act illegal.)

Or, the fascinating, morally ambiguous case of Holly Bosscher, a Dutch woman, whose hard life and chronic depression led her to an unshakable desire to end her life and whose death changed the legal physician aid-in-dying laws in Holland to include “unrelieved and existential pain” as a legal grounds for a suicide.

Cote also brings a number of rich new details to the by-now familiar story of Derek Humphry’s wife, Jean, who in 1975 asked her husband to help her procure the drugs necessary to end her life. (She suffered from metastasized breast cancer and was in terrible, unrelieved pain.) Despite the fact that it meant committing a felony under England’s draconian Suicide Act, Humphry chose to help his wife end her life and an activist – and a movement — was born.

Humphry’s difficult second marriage to Ann Wickett, which nearly derailed the Hemlock Society, is also described in great detail and, frankly, Hollywood could not have written a more personally and professionally destructive spouse for a man in his position. But somehow, Humphry slogged through it and, aided by the phenomenal success of his how-to-die guide, Final Exit, the Hemlock Society grew and flourished.

Unfortunately, when Humphry stepped down as director in 1992, the group fell prey to in-fighting and lost much of its public support. Re-named “End-of-Life Choices” by its board in 2003, membership plummeted. End-of-Life Choices then merged with another right-to-die organization and became Compassion & Choices in January of 2005, headed up by Barbara Coombs Lee.

Dubbed “the Hemlock Society, decaf version,” by one former Hemlock board member, C&C immediately distanced themselves from Caring Friends, the Hemlock Society’s controversial “dying-member assistance program,” and then returned the insult by likening the teaching of self-deliverance methods to promoting “coat-hanger abortions.”(The Final Exit Network has continued the work of Caring Friends despite the arrests of seven of its members.)

In his low-key, almost pastoral way, Cote admonishes both sides and makes an impassioned plea to end the ideological turf wars. There is a place for pushing legislative reform — and good reason to continue teaching do-it-yourself deliverance methods, he says. And, as In Search of Gentle Death shows us, the death-with-dignity activists have much to be proud of. With this important testament to their achievements to bolster them, the future of the movement — and those of us who will benefit from their efforts — looks bright indeed.

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Dr. Death’s Final Decision

June 4th, 2011 — 9:59pm

After championing the rights of the sick and suffering to get help ending their lives — and providing that “help” to scores of terminally ill patients — Dr. Jack Kevorkian died of natural causes on Friday at the age of 83.

According to Geoffrey Fieger, the lawyer who represented Kevorkian in several of his trials in the 1990s, Kevorkian was too weak to take advantage of the option he had offered others and had long wished for himself. “If he had enough strength to do something about it,” Fieger told a news conference in Southfield, Michigan, “he would have.”

If that is true, there is something almost epically tragic about the fact that a man who fought so long and hard for patients’ right to die on their own terms, wasn’t able to take advantage of this option in the end. But then who is to say “Dr. Death” didn’t simply change his mind? He’d apparently been suffering from kidney failure and pneumonia for over a month, long enough to plan his own death if he’d wanted to. He was a doctor and entirely familiar with how to end a life quickly and painlessly. And given his well-known penchant for drama and attention, you’d think he’d want to make himself exhibit A for what he believed in. (At the start of his third trial, he showed up in court wearing Colonial-era clothing to show how antiquated he thought the charges were and, after videotaping himself helping to kill a patient, he voluntarily handed the tape over to “60 Minutes.”)

The fact that Kevorkian didn’t end his own life is, to me, a potent reminder that our political beliefs are not always in the driver’s seat when it comes to death. Just as one can imagine even the staunchest anti-assisted suicide crusader wavering in the face of extreme pain and disability, I have found that certain pro-assisted suicide people seem to believe that killing oneself is actually a better option than dying naturally. Often, when I mention that I wrote a book about my mother’s decision to end her life after a long illness, people say, “Oh, well I definitely plan to do that. I’ve already made it clear that that the minute I get a disease, I want someone to take me out back and shoot me!”

I get the humor but there is a glib — even fashionable — assumption that suicide, assisted or not, is a good way to go. I want to ask: How would your kids feel if you do that? Your spouse? And how would you feel if it was them making that choice? I’m a big supporter of the Death with Dignity Laws in this country, but frankly, as long as I’m not in pain and have some quality of life, I’m planning to “go naturally,” just like Kevorkian did in the end.

The idea that ending your life is going to be easier and more straightforward than letting nature take its course is something of a happy illusion. Having witnessed both my parents dying in very different ways, I know that even the best laid plans for death can go awry. It reminds me of the “birth plan” I drafted when I was pregnant. Somehow, between planning the perfect play list and specifying that I didn’t want an episiotomy, I forgot to factor in throwing up, forgetting to breathe, and the uncontrollable urge to yell obscenities at the nurse. So much for my beautiful birthing experience.

It may be a cliche, but there really are some things we can’t control and even for strong-minded people like my mother, who was determined to plot the details of her “end,” you simply cannot know how you will feel when the day comes. In fact, my mother set and changed her “death dates” several times, discovering on the chosen day that she wasn’t quite ready to go after all.

In Bill Moyers’ PBS special on assisted suicide a few years ago (“On Our Own Terms: Moyers on Dying”), not one of the people Moyers followed actually ended up killing themselves. There was always one more event they wanted to stay alive for: a birthday, or a grandchild’s graduation. Every one of his subjects waited until it was too late and no longer had the physical capability to manage it. All, except for one woman who died from natural causes before she had a chance to take the pills she’d stockpiled. Pulling the plug turns out to not always be so easy.

Adding to the vagaries of the psyche is the unpredictability of the body. Unless you live in one of the three states where physician assisted suicide is legal (Oregon, Washington and Montana) and have access to a group like Compassion & Choices who will help make sure you are taking the right dose of drugs, chances are you will not know how to calibrate the means of death. In my mother’s case, stopping eating and drinking took far longer than she’d expected, and an attempted morphine overdose failed. Although she did ultimately manage to end her life, it was not the controlled, predictable event she’d hoped for.

I read recently that the issue of assisted suicide splits this country almost completely in half, making it an especially divisive and contentious issue. I would respectfully suggest that both sides may have lost sight of the fact that death can – and will — make a mockery of even the most carefully laid plans, the most passionately held beliefs.

And who knows, when it came down to it, maybe Jack Kevorkian simply wanted to stay alive and was hoping he might recover. Or maybe his lawyer is right and he wished someone had been there to help him speed things along. We will never know and that is as it should be. Because as politicized as it has become in this county, death is ultimately a private experience, fraught with unknowns. And Dr. Kevorkian, like all of us who support assisted suicide as a legal and moral principle, had the right to change his mind.

This piece was published in Salon on June 4th, 2011.

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Doing Time for “Doing A Kevorkian”

April 6th, 2011 — 5:24pm

Most people convicted of murder are understood to have stolen their victim’s life. To have violently ripped it away against the person’s will. Not so Kenneth Minor, a 38-year-old man who was sentenced to 20 years to life this week for killing 52-year-old Jeffrey Locker. Minor’s defense? Locker begged Minor to “do a Kevorkian” on him. According to Minor, he was only helping the guy out.

The story offers a bizarre new twist on the assisted suicide debate currently playing out in courtrooms and hospitals all over this country. Locker was certainly not the typical candidate for ending one’s life via assisted suicide. He wasn’t old or suffering from unremitting physical pain. He wasn’t battling a chronic illness.  He was, in fact, in his prime, a seemingly successful motivational speaker and “behavior modification expert” who lived with his wife and three children in Valley Stream, New York.

So why did he want to die, and why did he insist on involving a complete stranger?

While I don’t profess to know the inner workings of Locker’s mind, according to testimony in the trial, he was in serious financial trouble due to investments in a Ponzi scheme. Rather than face the consequences of his financial misdeeds, he began trolling East Harlem looking for men who would murder him in exchange for money. One of these men, Melvin Fleming, testified that Locker told him he was “looking for someone to make him dead.”

According to evidence presented in the trial, Locker’s determination to make it appear he’d been murdered also had a logical – if morally questionable — explanation: He wanted to make sure his family got the millions of dollars in insurance money he’d left for them. (Insurance companies generally don’t pay out in the case of a suicide, thus the need for a staged murder.)

And so, on a July night in 2009, after a couple of months of looking, Mr. Locker found a willing accomplice: Kenneth Minor. According to Minor, Locker instructed him to bind his hands and then hold a knife against the steering wheel while Locker repeatedly thrust his chest into the blade. This strange act of mercy may have gone undetected — buried beneath an already-steep pile of unsolved murders in New York City — if not for a surveillance tape, which caught Minor entering Locker’s car. (Minor was also later caught using Locker’s A.T.M. card. It was his payment, Minor claimed: the reward Mr. Locker had promised him for assisting in his suicide.)

One can’t help but wonder if Locker’s family might have preferred him to “help” them less, but instead, stay alive and face the financial and legal fallout from his alledged misdeeds.  But none of them were in the courtroom on Monday when Minor was sentenced. Instead, Minor had the last word. Fighting back tears, he offered his condolences to Mr. Locker’s family and begged the judge for leniency.

“Only two people in the world know what happened that night,” Mr. Minor said. “And one of them is not here no more. But he did not want this for me, for me to lose the rest of my life.” He added: “In the end, Mr. Locker is where he wanted to be. I can’t take that back now, but I’m no animal. And I ain’t got no malice in my heart.”

While the jury did not buy Kenneth Minor’s defense and the judge ended up giving him 20 years to life, arguing that he’d been willing to commit an act of extreme violence for money, I think it’s only fair that — in the press anyway — Locker and his choices were also put on trial.

I have never understood the view that committing suicide is a selfish act. How can the motivations of someone who is acting out of extreme pain – either mental or physical – be criticized and judged by normal standards of behavior? But killing yourself to avoid the shame of facing your own wrong doings, engineering your death for the material gain of those left behind, and then involving an outsider in your own violent, bloody end, is enough to make me reconsider my position. Yes, I feel sorry for Locker and his desperate quest for “assistance,” but I feel sorrier still for Mr. Minor who was desperate enough to think that helping someone to die would be worth any amount of money.

In the end, does this case tell us anything important about the meaning of assisted suicide, as it is normally defined?  Perhaps only this.  I don’t think anyone, including the most rabid right-to-die advocates, would say that what happened on the street in east Harlem two years ago was an acceptable form of assisted suicide. And whatever reasons Mr. Minor had for agreeing to accommodate Mr. Locker’s brutal final request, our legal system soundly rejected them. How could it do otherwise?

One only hopes that this case will not distract us from the more important issues surrounding assisted suicide or make it more difficult for those who make this choice — not from selfishness or shame — but from courage and strength, and who choose to do so surrounded by loving helpers, not paid strangers.

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Dr. Death — Up Close and Way Too Personal

April 25th, 2010 — 4:06pm

When my mother was planning how to end her life in 2001, she joined the Hemlock Society and arranged to have one of their “Caring Friends” come to her house. The meeting with Bud, an overweight man in a black suit and bolo tie, is one of the central scenes in Imperfect Endings.

Like the Hemlock-friendly psychiatrist who had prescribed a lethal amount of Seconal for my mother several months earlier, Bud seemed to have no qualms about helping my mother to die. (My mother had suffered from Parkinson’s for many years, but was nowhere near death.) But it was what Bud proposed that disturbed me the most.

My mother would need to procure a plastic bag, tubing and a canister of helium.  On the designated night, he and another volunteer would arrive. My mother should be alone except for any family members who knew about and supported her decision.

“Then,” he drawled, pulling out what looked like a dirty white headband, “your mother puts the plastic bag over her head, feeds the tubin’ up underneath it, and puts this band around her neck to secure it. She then reaches down and releases the valve on the canister of helium. The helium will cause her to fall unconscious in just a few minutes. When she’s dead, we take the plastic bag, the helium and everythin’ and leave the house. You call the medical examiner’s office to certify that she’s dead, and we’re done.”

Much to my relief, my mother seemed to realize that Bud was not the last person she wanted to see on earth and she did not, ultimately, choose this route. But after spending last Saturday night watching “You Don’t Know Jack” on HBO, I had to wonder: If Dr. Kevorkian had been available, would he have been the next person my mother turned to?

Fortunately, I never had to find out as “Dr. Death” was languishing in a jail cell in 2001. Three years earlier, he’d made the rather bizarre decision to kill one of his patients (Thomas Youk) by injecting him with potassium chloride. Up until then, Kevorkian had helped patients kill themselves by flipping the switch on his “mercitron” (a kind of death machine) or inhaling gas – again activated by the patient’s own hand.

Compounding the situation, Kevorkian filmed Youk’s death and gave it to 60 Minutes. Why did he do this? It seems that both he and his cause were fading from the public limelight by then and he couldn’t bear it. In other words, it was a media stunt, pure and simple, one that landed him in jail for eight and a half years. (He was released in June of 2007 at the age of 79.)

Besides being something of a media whore, Kevorkian was also a full-on eccentric with a major social gene missing. “There’s nothing further to be gained from talking to you!” he shouts at Janet Good (Susan Sarandon), a Hemlock Society supporter, who is clearly an ally, but isn’t willing to let him use her house as a site for one of his mercy killings. And he seems to have an almost pathological fear of food.

“This is full of fat and sugar,” he grouses to his lawyer when he is handed a piece of pie. “Are you trying to kill me?” “Just eat the fucking pie, Jack,” the lawyer shoots back, clearly tired of the skeletal Kevorkian’s ascetic eating habits. (In another scene, he growls,“Decaf is for cowards.”)

But while much of the humor in the movie comes from showing Kevorkian’s odd, antisocial behavior, there is clearly much to admire about the man — at least as he is portrayed by the screenwriters for HBO. In fact, the whole movie is something of an apologia, starting with the title, which is a fragment of a longer title: “Until You Know the Whole Story, You Don’t Know Jack.”

So while we see many instances of Kevorkian’s self-aggrandizing behavior, we also see his compassion, even tenderness, when sheparding his patients through the last moments of their lives. “It’s not to late to stop now, my dear,” he tells Janet Adkins, the first woman he helps to die who seems to hesitate before switching the valve on the lethal canister of gas at her side. “You wouldn’t offend me.” And then, when she determinedly pulls the switch, he strokes her hair as she dies, a moment that brought me to tears.

And time and again, we see his deep commitment to ending his patients’ suffering: his deep belief that he is helping them fulfill a basic human right to choose death over suffering. When his sister objects to his helping Adkins because her early dementia makes her a difficult first “test case,” he demands: “But what about her? Who cares what people think. It’s what my patient feels.”

It’s also revealed that much of what motivated Kevorkian was guilt over having allowed his mother to suffer at the end of her life. “I failed her,” he tells Good in a rare moment of introspection. “She once said to me, imagine, Jack, the worst toothache in the world. Now imagine that toothache in every bone in your body.”

This is one of the great strengths of the film: we see Kevorkian’s sense of mission and his compassion, but also his self-delusion and hubris. In the most brilliant scene in the movie, we also see him confront defeat. Having insisted on representing himself against murder charges in the Youk case, he quickly finds himself in way over his head. Unlike previous court cases, he is not being accused of assisted suicide, he is being accused of murder and it’s almost as if Kevorkian cannot comprehend this. Pacino, who is fabulous throughout with his flat midwestern twang and awkward gait, is completely riveting as he leans over the defense table, taking on and off his glasses, his face a study of exhausted defeat.

So why, given all Kevorkian’s strengths, am I relieved that my own mother’s path to “self-deliverance” never led to Kevorkian’s door? Well, just as I hated the idea that “Bud” might have been the last person my mother saw on this earth, I feel the same way about Kevorkian.

This is largely due to one scene that was so disturbing, I only hope to forget it as soon as possible. It happens about halfway through the movie, when Kevorkian has switched from the “mercitron” to using gas. In an attempt to save his meager supply of gas, he builds a plastic box to intensify the effects. In this scene, he places the plastic box over the head of an elderly man with emphysema and then reacts impatiently when the box grows unbearably hot and the poor man rips it off his head, shouting, “Take it off, take it off.” In the end, realizing that he is only coming back to the same hell, he agrees to place the box back over his head. His head soon drops forward against the plastic contraption as his wife cries out in horror.

Having talked to Derek Humphry about the plastic bag/helium option that he describes in the most recent edition of Final Exit, I understand that it does not have to be so terrible. But what really bothered me in this scene was Kevorkian’s cold response, not only when the man was dying, but afterwards when his friend, Neal Nicol, played by John Goodman, chastises him for trying to “cut corners.”

“These are my decisions to make, Neal,” he snarls. “Mine alone.”

This scene was so repulsive to me — perhaps because I can imagine a scenario where that was my mother under Kevorkian’s plastic hood– that for all of the movie’s careful efforts to show Kevorkian in a good — if imperfect — light, I was no longer buying it. I still believe in what he fought for – the legal right to have a physician help you end your life in a quick and compassionate manner – but in the most profound way, getting to “know” Jack, was to find him pretty despicable.

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