Kevorkian Trial Renews Debate over Euthanasia

Article excerpt

AS Michigan state attorneys prepare again today to prosecute accused suicide accomplice Jack Kevorkian, a quiet but far-reaching debate is unfolding in American homes and hospitals over the ethics of physician-assisted suicide.

Both opponents and advocates in the larger debate are highly critical of Dr. Kevorkian and his methods in helping 27 people kill themselves since 1990. Without the publicity surrounding Kevorkian, however, they say today's discussion might not be as widespread.

"{Kevorkian} is a terrible bedfellow, even if you are for it," says Prof. Ezekiel Emanuel, a medical ethicist at Harvard University. "On the other hand, he has raised the issue and I think a national debate is appropriate." Unless a last-minute appeal delays the case, Kevorkian will go on trial today for his role in two 1993 deaths.

The debate, which challenges the 2,500-year-old Hippocratic ethic of Western medicine, centers around whether doctors should be allowed to prescribe drugs to end the lives of requesting adult patients who are diagnosed as mentally competent and terminally ill.

Overall, support for legalizing the practice seems to be increasing among both the general public and doctors in the US, according to two studies reported in the latest issue of The New England Journal of Medicine.

In Michigan, 66 percent of adults and 56 percent of doctors surveyed approve of legalizing physician-assisted suicide; in Oregon, 60 percent of doctors said it should be legalized in some cases, the studies show.

Moreover, many doctors are already quietly breaking laws to accommodate patients who seek to die, according to the studies and experts in medical ethics. In the Oregon study, for example, 7 percent of doctors responded that they had complied with patients' requests for prescriptions for drugs with which to end their lives.

Ballot initiatives

Underscoring the trend, a dozen states including Washington and California have introduced legislation or ballot initiatives in recent years to legalize physician-assisted suicide. So far only Oregon has passed a law, but the 1994 Oregon Death with Dignity Act, which won 51 percent of voter support, has not been implemented because of court challenges.

Key federal court rulings are expected later this year on the Oregon law, as well as on efforts to decriminalize physician-assisted suicide in Washington and New York States.

Medical ethicists offer different explanations for the shift in public attitudes. Some cite the aging population. Others say advancing medical technology has been successful in prolonging peoples' lives, but can add to human suffering in prolonged cases of illness. AIDs has fueled the discussion, too.

More than anything, supporters of physician-assisted suicide stress the need to relieve suffering and to allow patients to make individual choices free from intrusive doctors or a paternalistic state - what they call "death with dignity." Practically, they argue, it is better to allow assisted suicide under controlled and restricted conditions than to tolerate today's unmonitored suicides. …