Jack Kevorkian. The name arouses passions in the United States, and intense ethical questions in the minds of many around the world, who followed the dimunitive, wiry pathologist’s lonely fight against the US legal system in the late 1990s. I vaguely remember reading about the man in those days, when he was portayed in the world media as some sort of a psychopathic serial killer, rather than someone fighting for a cause he believed in.
He was released from prison on June 1st 2007 after being incarcerated for more then eight years for second degree homicide. Killer to some, and hero to many, the frail 79 year old ‘Dr. Death’ has not lost any of the fire that he spewed when he challenged the legal system of the United States to stop what he considered his mission of mercy.
Kevorkian appeared on Larry King Live on CNN on June 4th, perhaps the only complete interview by Larry King that I ever sat through. It was fascinating, and the questions it provoked were disturbing.
Jack Kevorkian believes, with as much conviction as is possible to believe with, that human beings have a right to their own life. He believes that any law which prevents a person from taking his or her own life is unjust and unnecessary. He is by no means the first person to think on those lines. The debate over the right to die is as old as the earliest philosophers. But Kevorkian maintains that his fight is not about the rights of the patient. His fight is about ‘his’ right as a physician and an ethical human being to legally end, or help to end, the life of a patient who has expressed an explicit desire for death, to put an end to his or her suffering.
And that is where traditional supporters and campaigners for euthanasia have always found Kevorkian to be too radical. He was so convinced of the morality of his view of the issue, that he went so far as to invent machines, the ‘Thanatron’ (death machine) and the ‘Mercitron’ (mercy machine) to enable the patients carry out the deed themselves. He advertised in papers for ‘death counseling’ and even tried to place ads for his machines in medical journals. He was refused, of course. He helped more than a hundred and thirty people end their lives, and all this with the full knowledge that he was in violation of the law. Indeed, as he pointed out in the Larry King interview, he invited the legal spotlight on him. He wanted the prosecutors to go after him. He wanted to get this issue in the mainstream and take it all the way to the Supreme Court. And he was prepared to pay the price for his beliefs.
Nations where euthanasia is legal, such as the Netherlands and Belgium, permit ‘voluntary assisted suicide’. What that means is that the patient requests an end to life voluntarily, and that the information, guidance and means to do that is provided by another person. The actual act is carried out by the patients themselves. In most nations ‘euthansia by omission’ is legal, even if it is not explicitly laid down in law. This is a situation where death is brought about by withholding essential care or food and water from the patient (eg. the recent Terri Schiavo case in the United States). Kevorkian is totally against this as he considers it inhumane and likens it to Nazi experiments with euthanasia. According to him, these countries and the state of Oregon in the US, where voluntary assisted suicide is legal, do not make the cut. His reasoning is that since they do not allow anybody other than the patient to carry out the act, it effectively cuts off the most deserving beneficiaries of the law, patients who are so devastatingly disabled that they cannot lift a finger, let alone have the ability to collect information and means to end their own lives. What happens today when such patients request death with dignity is that they are physically unable to help themselves and nobody else is allowed to help them either, leaving them in limbo. A physician risks losing his or her license if s/he is involved in assisted suicide procedures, at least in Oregon.
Kevorkian has always maintained that his patients were terminally ill and requested their own deaths while their mental faculties intact and they were capable of taking rational decisions on their own. Two obvious questions arise here. One, the definition of ‘terminal’, which seems to be changing everyday with advances in medical science and continuing debate on medical ethics. Two, the verification of the mental capacity of the patient to take such a decision. Kevorkian claimed that all his patients had to undergo psychiatric evaluation to determine whether they were making a conscious rational decision and that they were not being covertly pursuaded or coerced by someone close to them. Autopsies on some of his patients showed later that they were not terminally ill, but were probably just severely depressed and suicidal.
This provides a lot of fodder for campaigners against the right to die. Though often dismissed as religious zealots by people of the opposite viewpoint, they have many valid points which, though quasi-religious, are rooted in questions of ethics, much like most of religion itself. Most of the objections are to the ‘terminally ill’ tag. According to Kevorkian, a terminal illness is one that “curtails life, even for a day”. The state of Oregon, on the other hand, puts a time-frame on it…six months to live. Opponents say that it is scientifically impossible to predict the life expectancy of a patient, and many survive for long periods, even after being labeled terminally ill. Another objection is to the perceived cheapening of the value of life. The contention is that for most severely disabled persons, depression comes about not due to the hopelessness of life itself, but due to the lack of support from society for their condition. And that can be changed. Depression can be cured. In fact, for certain severly disabling illnesses such as multiple sclerosis, depression is symptomatic. And quite a few patients of Kevorkian were suffering from MS. They are also of the view that assisted suicide places no value on the sanctity of life. It lays no emphasis on resolving the issues which causes people to look towards death as a relief. Instead it provides death itself as a solution. Then of course, there are arguments for the very real dangers of voluntary assisted euthanasia turning into non-voluntary euthanasia for monetory reasons or simply to do away with the terminally ill, mentally ill or simply, the old.
When asked by Larry King whether he believes there is a God, Kevorkian said no, and then hastened to add, “there could be one though”. When Larry said “Nobody knows”, he replied, “That’s right. That’s why I don’t believe it.”.
Most western cultures, steeped in the traditions of Semetic religions, tend to see things in black and white. Laws against taking your own life almost always have religious roots. I was interested in finding out the Hindu religion’s position on euthanasia. Unlike Semetic religions, which lay a lot of emphasis on fixed positions of right and wrong, eastern religions mostly tend to judge actions by their consequences. So, not surprisingly, what I learnt was that Hindusim has various points of view on this topic. Some believe that to help end a life of pain and suffering would be to fulfil their moral obligations, while others feel that helping to end any life is against the natural order of things and will interfere with the cycle of birth and death laid out in our fate.
The Indian legal system, however, has always looked towards western culture and legal traditions for guidance. And in this case too, it is no different. Suicide or abetting suicide is illegal under Indian law. Section 309 of the Indian Penal Code, which criminalizes suicide, was challenged in 1994 in the Supreme Court by petitioner P. Rathinam. The court ruled in his favour, giving hope to champions of euthanasia. But in a startingly contradictory verdict in 1996, the constitutional validity of Sections 306 and 309 were upheld. The court remarked that Article 21, which states that all Indians have a right to life and personal liberty, cannot be widened to include euthanasia, and that suicide and assisted suicide were made punishable by law due to “cogent reasons in the interest of society.”.
In the middle of this legal muddle, extraordinary cases appear and disappear from public consciousness. In 2004, Venkatesh, a 25 year old patient from Hyderabad, suffering from severe muscular dystrophia and with only days to live, wanted to be granted the right to die, so that he could donate his organs before they deteriorated one by one to the point of becoming useless. His plea was rejected a day before his death by the Andhra Pradesh High Court. It ruled that by Indian law, a person could not donate his vital organs if he was not brain dead, and by granting the right to Venkatesh, the court would be effectively legalizing his right to take his own life. This set off an intense and unprecented debate about the right to die in India, but over time it dropped off from the media radar.
People like Kevorkian, though polarizing figures, help bring these issues to the forefront. We in India too need to be jolted back to address this question again. Laws should be enacted and people should be educated about the concept of a ‘living will’, which lays out your wishes in terms of treatment, and if necessary, euthanasia, in the unfortunate event of a situation where one becomes incapacitated.