Dollars and Death: The Question of Physician-Assisted Suicide
Part I
Living in a neoliberal era—where the interests of business dominate government and public policy, and in a climate that more and more measures one’s worth by economic efficacy—demands that we scrutinize the “right” to die beyond a liberal expansion of individual rights. We must look at the timing of these proposals.
Why assisted suicide now, with the increase of mysterious viruses and incurable illnesses like chronic fatigue, AIDS and fibromyalgia, which require costly drugs and long-term care? Why now, with managed care corporations rationing health care, and with public health care under the budget ax?
In his latest book, Freedom to Die: People, Politics, and the Right to Die Movement, Derek Humphry, cofounder of the Hemlock Society, the oldest and largest pro-euthanasia/assisted suicide group, says it will be the unspoken argument for assisted suicide—cost containment—that will ensure the eventual passage of laws legalizing assisted suicide and euthanasia.1
Humphry argues it will be the drive to save health care dollars that will push public policy in their direction, not the drive for increased autonomy (as the Death with Dignity slogans assure the public). Humphry is right to make the connection. But some have unabashedly been speaking the unspoken for years now.
The convicted murderer Kevorkian exposed his real agenda in a Written Statement to Court (August 17, 1990): “The voluntary self-elimination of individuals and mortally diseased or crippled lives taken collectively can only enhance preservation of public health and welfare.”2
Courts are listening to this line of reasoning. When the Ninth Circuit Court in San Francisco ruled that individuals have a constitutional right to physician-assisted suicide, it specifically targeted the handicapped as “beneficiaries,” stating that it may be acceptable for “competent, terminally ill adults to take the economic welfare of their families and loved ones into consideration” when deciding whether to live or die, and defended the use of assisted suicide to control medical costs.
An editorial in the Weekly Standard, the voice of the GOP majority, concluded in 1995, “Sick people are expensive. The dead are a burden to no one. Fifty years ago there was whooping cough and diphtheria. ‘The child either lived or died, and, for the most part, did so quickly and cheaply,’ noted [Columbia Professor Willard—Ed.] Gaylin. Now that child ‘will grow up to be a very expensive old man or woman.’ … Ultimately, the only answer is some kind of rationing, under whatever guise.”3
This gives cause to ask what is really happening when Kevorkian and others talk about voluntary self-elimination. Are people who seek assisted suicide choosing death or being cornered into it by inadequate national disability policy, a lack of quality long-term and palliative care that, in their absence, makes life so unbearable that death seems preferable to life?
Oregon, which legalized assisted suicide [in 1997,—Ed.] made changes to its Medicaid policy so that the state will prioritize payment for physician-assisted suicide since federal laws prohibit funding. Physicians there reported that the state also restricted funding for a key pain medicine, Oxycontin, making this needed treatment virtually unavailable to many chronically or terminally ill patients; effective doses were not available to patients with conditions like amyotrophic lateral sclerosis (Lou Gehrig’s disease), diabetic neuropathy, multiple sclerosis, reflex sympathetic dystrophy, and a host of painful, disabling, or fatal disorders. Disability advocates have reported that there are difficulties in obtaining the hours of attendant services needed to remain at home in Oregon.
Surveys have consistently found that most people would rather continue to live at home than in a nursing home. What has not been known until recently is that the aversion to nursing homes is so strong that a new study of seriously ill people in hospitals found that 30 percent would rather die than live forevermore in a nursing home.
Research on those who elected to die under the Oregon law reveals that people did so over concerns about loss of autonomy or loss of control of bodily functions—fears which are not being addressed by uniform public policy like quality in-home care and psychological support services to ease the transition to disablement.
Instead, Humphry’s answer, and increasingly that of more assisted suicide advocates, is to give elderly and disabled people the “freedom” to kill themselves rather than to demand a national attendant service (PAS) program be put in place that would enable elderly and disabled people to remain in their homes rather than being warehoused in institutions.
In the Managed Care Era it is essential to ask, will people choosing death be the victims of a health care system which is more oriented towards reaping Wall Street dividends rather than relieving pain and depression, providing comfort at the end of life—care which is costly to health corporation and state budget bottom lines?
With the advent of managed care, there has been a payment paradigm shift. In the name of containing costs, HMO hospitals and doctors no longer get paid for individual services rendered; they get paid a flat fee. This shift means that those needing the most health care are no longer perceived as an asset (bringing more money in) they are seen as a liability (draining the profits).
Furthermore, managed care corporations manipulate fees to control gatekeeper physicians’ approval of expenditures on patients; doctors are given bonuses for keeping costs low and often find their contracts revoked when they do not conform to HMO administrators’ directives.
Dr. Linda Peeno, a physician who found herself in such a predicament, testified before the House Commerce Committee (May 30, 1996):
I wish to begin by making a public confession. In the spring of 1987, as a physician, I caused the death of a man…. Although this was known to many people, I have not been taken before any court of law or called to account for this in any professional or public forum. In fact, just the opposite occurred: I was “rewarded” for this. It brought me an improved reputation in my job, and contributed to my advancement afterwards. Not only did I demonstrate I could do what was expected of me, I exemplified the “good” company doctor: I saved a half million dollars!4
Is all this not sufficient evidence to conclude that there is a direct link between physician-assisted suicide and efforts to reduce health-care spending on poor, sick, and disabled people? The issue of physician-assisted suicide must be viewed within the context of an economic order which is eviscerating the social contract by encouraging government to retreat from its responsibilities to the public’s welfare. Will the public now in support of assisted suicide hear the “unspoken”?
Being a veteran of the war for truth during the Kevorkian era of the assisted suicide debates, it astounds me when I see that some companions battling for social justice are still entangled in the Kevorkian-as-humanist illusion web. Someone emailed me recently that before Kevorkian was jailed they saw an all-smiles Tom Cruise go over to Kevorkian at a Hollywood party and pat him on the back. Vonnegut fantasizes about being guided into and back from death by Jack and his death machine in “God Bless You, Dr. Kevorkian.”5 Of course, Kevorkian is the number one martyr for the Hemlock Society which recently aired the video version of “Final Exit” on Oregon public access TV.
Not Dead Yet, which has taken the lead in opposing Kevorkian, calls the Hemlockers “the 4 W’s: White, Well-off, Worried, and Well.” Organizer Diane Coleman explains, “They [Hemlockers] don’t care how many of our people are encouraged—even pressured—to die, so long as they themselves can have the security of a clean, neat, sanitized suicide at the hands of a medical professional.”6
Despite the fact that Jack has been stripped of his doctorhood in several states and, most recently, jailed for murder, some believers hold onto the image of Kevorkian as a symbol of humanism.
It follows that my question must be: Does Kevorkian have the humanists fooled or what? Or maybe I misunderstand what humanism is. Is it humanistic, for instance, to be willing to step in and help a disabled person die rather than provide the means to live? Is it humanistic (or even defensible) to assist an obviously depressed forty-three-year-old woman to her death who was diagnosed with a nonterminal but impairing condition and then abandoned by a husband who also took her children away from her? That is what Kevorkian did to the vulnerable Sherry Miller who needed antidepressants and a good lawyer, not a visit with Dr. Death.
Is it humanistic to assist a quadriplegic to his death, do a botched job taking out his kidneys, and then dump him at a hospital doorstep? That is what Kevorkian did to Joseph Tushkowski. The Oakland County Medical Examiner, L. J. Dragovic, called Tushkowski’s body a scene from a slaughterhouse.7 For the uninformed, Kevorkian’s self-stated goal (prescription medicide) is to establish a “new specialty” of obitiatry (that is, medical killing), and to carry out human experimentation and transplantations in death centers he planned to set up all over the country. Harvesting Joseph’s organs must have been practice for this scheme.
Is it humanistic to assist in the suicide of a disabled man who has been waiting for nine agonizing months for a wheelchair from his horrible HMO? That is what Kevorkian did to Matt Johnson. Matt’s wheelchair came the day after Kevorkian’s visit—one day too late to free him from his seemingly permanent bed-ridden state and the actually permanent state of death.
Is it humanistic for a doctor to fatally inject a man with whom the doctor has only had two meetings within the 48 hours before he kills him? When asked later by the Oakland Press what Thomas Youk’s last words had been, Kevorkian responded, “I don’t know. I never understood a thing he said.”8 That was Youk’s “dignified” death at the hands of this “understanding” and “compassionate” administrator of death.
Is it humanistic to aid in the death of a man whose greatest fear is that he will be forced to live in a rat-infested nursing home? That was a reason Wallace Spolar gave when he called on Kevorkian and engaged his services.
Published reports and court records indicate that sixty-six of Kevorkian’s ninety-three “patients” did not fall within the generally described category of terminally ill (life expectancy of six months or less). Janet Adkins, who had recently been diagnosed with Alzheimer’s, was reported to have played tennis the week before her appointment with Kevorkian. Judith Curren had chronic fatigue, was depressed and had filed domestic abuse charges against her husband two weeks before her killing. Yet another was a depressed battered wife who did not have Multiple Sclerosis as claimed. Kevorkian, who defines terminal illness as “any disease that curtails life even for a day,” aided all these people into the irreversible state of death.
Is it humanistic to assist people to a premature death when they suffer ugly economic circumstances and social conditions and need help from society to get through a difficult time? Isn’t it humanistic, rather, to fight for resources and social justice and to avoid death as the social “solution”?
Why is it that some people are so quick to join the death-is-the-answer position when it comes to disablement and don’t seem to be able to see disability as a neutral factor in life? Why is disability so charged for them? I can only surmise that these non-disabled people fear disablement so much that they automatically assume that they are doing us a favor by supporting our right to die. But, in a social justice context, if the right to die was an equal opportunity matter and not specifically directed at those with chronic conditions, then the advocates would give healthy twenty-year olds the same right to die too, wouldn’t they?
Well-informed individuals on other social justice issues have come up to me on more than one occasion and said, “I just don’t see how you do it. I couldn’t do it”—meaning, get on with my life “in spite of” my disability. These people seem to think that they could not accept life with a disability and make projections about what they could or would not do if they were in my shoes, but this is often just a first take on a complex continuum of experience. For instance, I have quadriplegic friends who did contemplate suicide their first weeks of disablement but are glad that the option of physician-assisted death wasn’t available because they got over their depressions, adjusted to the disability, and are living out their lives being a comedian, a spouse, and/or a parent. A good friend of mine has lived with multiple sclerosis for about a decade now. Her son just finished college.
Further, ableist and individualist projections about the experience of disablement are a complete avoidance of the headier collective issues at stake. Why don’t these same people ask me, “are disabled people getting the health care and services that they need?” Don’t they know money is being valued over people in the health care system? Don’t they know people are still forced into nursing homes against their will? Don’t they also know about the role of race and poverty discrimination in the health care system? How about acknowledging that ableism plays a role similar to race and class?
What well-intentioned humanists miss, it seems, is that economics are in the background of the “right to die” movement. […]
Who are the stake holders? The Oregon assisted suicide bill was authored by an HMO executive. Vice President Barbara Coombs Lee of Ethix Corp., was chief petitioner of the measure which created Oregon’s law legalizing physician-assisted death. But media reports concerning Coombs Lee failed to make much of her professional occupation within a health insurance group. She was portrayed as a passionate ideologue who cared only for things like “patient autonomy,” an end to “intolerable pain,” and offering “death with dignity.” Coombs Lee’s role as a financially motivated health industry hatchet woman was carefully buried throughout the 1994 campaign. Ethix Corp. embraced the new “treatment,” stating that they “welcome broad coverage for assisted suicide in a medical economic system already burdened.” A lethal dose in Oregon costs only $35 to $50; compare that to one day’s stay in a hospital at about $1,000. […]
If Kevorkian’s actions accurately describe humanism, then humanism is aligned with the bourgeois eugenicists, Social Darwinists, corporate bean counters, and Malthusian population control zealots who target disabled lives as lives not worth living and label us a burden on society and their bottom lines.
Could liberal court decisions be used for their purposes? Of course! The issue of physician-assisted suicide must be viewed within the context of an economic order which is overriding public welfare and a health care system which is entrenched in profit making. Millions of Americans are uninsured or under-insured and in need of quality health care. Some insured have already found themselves denied life-giving treatments because HMO health care rationing is a real, not an imaginary, thing. Some may have found themselves without the cash to pay for the treatment or to pay a lawyer to intervene. Most anyone can become depressed because they do not want to be a burden on the family. One may not be ready to die, yet see no other way out.
Or perhaps the family might decide such a member is too burdensome and join the Hemlock society. The Hemlock Society issued a widely ignored press release which asked that family members and other “agents” be able to procure court orders to kill “a demented parent, a suffering severely disabled spouse, or a child” if their lives are “too burdensome to continue.”9 That’s involuntary euthanasia. According to the National Elder Abuse Incidence Study conducted by the Administration on Aging, several hundred thousand elderly Americans are abused by family members each year in this country. The FBI reports that 21.2 percent of homicides of individuals age 50 and over are committed by family members. [Hemlock Society cofounder Derek—Ed.] Humphry’s new video provides detailed information on how to disguise murders of disabled and elderly people as suicides.10
Would Kevorkian at your doorstep, then, look like a savior or a guy who was furthering his future at the expense of yours?
The genuine humanists, it seems, are not the ones joining the death culture. Rather, they are the ones fighting for a disability sensitive universal health care system, a national in-home care program like MICASSA (Medicaid Community Attendant Services and Supports Act), living wages, and an income floor beneath which no one falls. They are the ones calling for enforcement of civil and human rights and for imposing serious penalties on those who commit domestic violence. They are the ones searching for the means to build an economy which supports people’s needs over capitalist accumulation.
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Life is better than death, I believe, if only because it is less boring, and because it has fresh peaches in it.
—Alice Walker