Ends and Means

Suicide is not a medical procedure.

Jack Kevorkian's first suicide machine, which he called the Thanatron, delivered the same three chemicals commonly used to execute condemned prisoners: the barbiturate sodium thiopental to induce sleep, pancuronium bromide to paralyze the muscles, and sodium chloride to stop the heart. After his medical license was suspended in 1991, Kevorkian had trouble obtaining the drugs, so he switched to the Mercitron, a mask attached to a tank of carbon monoxide.

In both cases, death was a favor that Kevorkian, who proudly eschewed payment for his services, dispensed to people who convinced him they had good reasons for wanting to die. By contrast, the suicide kits that Sharlotte Hydorn sold from her home in El Cajon, California, were available to anyone with $60 and a mailing address. Unfortunately, to the extent that the government recognizes a right to suicide, it takes its cues from Kevorkian, who died last Friday at the age of 83, rather than Hydorn, a 91-year-old entrepreneur whose business was shut down by the FBI the week before.

Kevorkian, a retired Michigan pathologist, helped about 130 people suffering from terminal or debilitating and incurable diseases kill themselves between 1990 and 1998, when he crossed the line between suicide assistance and euthanasia by directly administering lethal drugs to a man with amyotrophic lateral sclerosis. Convicted of second-degree murder, Kevorkian served eight years in prison.

Yet the man whom the American Medical Association called "a reckless instrument of death" pointed the way to physician-assisted suicide, which has been legalized in three states and recognized by the U.S. Supreme Court as a legitimate medical treatment. Oregon's Death With Dignity Act, approved by voters in 1994, allows a patient to kill himself with doctor-prescribed barbiturates if two physicians certify that he has six months or less to live, he is deemed free of any "psychiatric or psychological disorder" that might impair his judgment, and he makes two requests separated by at least 15 days.

In 2006 the U.S. Supreme Court ruled that Oregon physicians who prescribe drugs for suicide cannot be prosecuted under the federal Controlled Substances Act (which requires a doctor's permission slip to purchase the drugs that are most suitable for this purpose). A 2008 ballot initiative created a similar system in Washington state, and a 2009 ruling by the Montana Supreme Court likewise allows doctors to help patients with terminal illnesses hasten their deaths.

Suicide assistance is so well established as the province of state-licensed physicians that the FBI is investigating Sharlotte Hydorn for selling "adulterated and misbranded medical devices"—i.e., elasticized plastic bags and plastic tubing that can be attached to a helium tank (sold separately) for a painless death by asphyxiation. The FBI, which raided Hydorn's home two weeks ago and carted away her merchandise, her sewing machine, and her computers, is also considering charges of mail and wire fraud.

Contrary to the common-sense understanding of fraud, the problem with Hydorn's kits, from the government's perspective, is that they work as advertised. That might be OK for a properly vetted, legally approved suicide authorized by medical professionals, but not for the do-it-yourself variety that Hydorn facilitated. If the government allowed that sort of thing, people might start to get the idea that they have a right to control their own lives.

Hydorn, who started her business after watching her husband suffer a painful, lingering death from colon cancer, says her aim is to help people escape unbearable suffering. Her critics object that what seems unbearable one day may not look so bad the next. "You have to make sure they don't want to end their life because they are depressed," a psychiatrist recently told ABC News, "because depression is treatable."  

That stance may sound cautious and compassionate, but it effectively strips people of the autonomy to decide for themselves when their lives are worth living. Suicide is not a medical procedure, and doctors have no special expertise to determine when it is the right choice. 

Jacob Sullum is a senior editor at Reason and a nationally syndicated columnist.

© Copyright 2011 by Creators Syndicate Inc.

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  • ||

    I don't get the whole "suicide machine" thing. Aren't there any tall buildings where these people are?

  • J[o]h[nn]y L[o][n]gt[o]rs[o]||

    I wonder how many Kevorkian/Hydorn supporters use suicides by gun to argue for gun control?

  • OO||

    u mean more gun control, unless felons, kids, & the mentally challenged START owing guns.

  • Rahm Emanuel||

    Don't be a fucking retard.

  • OO||

    ur boy johnny made the sweeping generalization.

  • Jerry Seinfeld||

    Sage!

  • MNG||

    I don't get the whole hand-gun thing. Aren't there any tall shotguns where these people are?

    It's about liberty, if they want to use a suicide machine instead of a tall building they should be able to.

  • Some Call Me. . .Tim||

    Suicide machines have huge carbon footprints. We need solar powered self destruction to win the future.

  • NeonCat||

    Giant magnifying glass? Die and cremate at the same time?

  • Realist||

    It only works on ants.

  • ||

    Death by high-speed rail is win-win.

  • mr simple||

    Maybe they want an open casket.

  • J[o]h[nn]y L[o][n]gt[o]rs[o]||

    They shut Hydorn down? Damn, and I was going to get MNG a kit for his bday.

  • Mike E||

    It would be interesting to see how a prosecution of attempted suicide would play out.

    "Sir, you attempted to kill a human being. For that we are going to lock you up"

  • Matrix||

    No. The penalty should be death.

  • Paleo||

    File this under "Irony can be difficult." There are a number of countries in which attempted suicide is a death-penalty offense.

  • Rather||

    Attempted suicide was a prosecutable offense in England

  • Paleo||

    And in Virginia. And it's still considered an infraction of common law.

  • rather||

    epi, I need your mailing address. I have an anniversary present I want to send you. The great news is it only set me back $60, and I can reuse it for storing my weed

  • ||

    Wouldn't that violate the restraining orders you two have taken out against each other? I am surprised posting on H&R doesn't violate them.

  • Elizabeth||

    Burton keeps coming back
    -not my fault

  • OK||

    Anyone else see the Invisible Man in a wheelchair in that photo?

  • Kevin Bacon||

    No

  • OK||

    I thought it was "conceptual" art. No?

  • Rather||

    It reminded me of asthma

  • Realist||

    You can not see the Invisible Man...because he is invisible! Duh!!!

  • J[o]h[nn]y L[o][n]gt[o]rs[o]||

    Through early morning fog I see
    visions of the things to be
    the pains that are withheld for me
    I realize and I can see...

    [chorus]:

    That suicide is painless
    It brings on many changes
    and I can take or leave it if I please.

    I try to find a way to make
    all our little joys relate
    without that ever-present hate
    but now I know that it's too late, and...

  • ||

    The game of life is hard to play
    I'm gonna lose it anyway
    The losing card I'll someday lay
    so this is all I have to say.

    [Chorus]

    The only way to win is cheat
    And lay it down before I'm beat
    and to another give my seat
    for that's the only painless feat.

    [Chorus]

    MASH
    The sword of time will pierce our skins
    It doesn't hurt when it begins
    But as it works its way on in
    The pain grows stronger...watch it grin, but...

    [Chorus]

    A brave man once requested me
    to answer questions that are key
    'is it to be or not to be'
    and I replied 'oh why ask me?'

    'Cause suicide is painless
    it brings on many changes
    and I can take or leave it if I please.
    ...and you can do the same thing if you choose.

  • ||

    And that is some pretty heavy shit for a 14 year old.

  • Realist||

    Yes indeed.

  • ||

    Mike Altman is the son of the original film's director, Robert Altman, and was 14 years old when he composed the song's lyrics. During an appearance on The Tonight Show Starring Johnny Carson in the 1980s, Robert Altman said that his son earned more than a million US dollars for co-writing the song while he only made US $70,000 for directing the movie.

    Music publishing been very very good to him.

  • Wind Rider||

    At the very least, doesn't sound like it's anything to make him kill himself over.

  • NTTAWWT||

    he composed the song's lyrics

    You write lyrics, and compose music.

    Carry on.

  • ||

    fixed it on wikipedia

  • NTTAWWT||

    At the age of 14 he wrote the lyrics to "Suicide Is Painless", the theme song for his father's 1970 movie, MASH

    While you're editing, MASH should be M*A*S*H

  • Rather||

    Holy shit NTTAWWT, your OCD is on overdrive

  • NTTAWWT||

    Accuracy in media is not a sin. Then again, this is a blog.

  • SWWT||

    medium

  • NTTAWWT||

    Media. Plural of medium. As in, all media. Hope this helps.

  • Paleo||

    That's CDO. It's like OCD, but the letters are in order like they should be.

  • rather||

    LOL or LLO :-)

  • Realist||

    You guys are nuts....but funny!

  • Ancap||

    Do-It-Yourself Suicide: Vote For Statism, In All Its Poisonous Manifestations...

  • Abdul||

    That stance may sound cautious and compassionate, but it effectively strips people of the autonomy to decide for themselves when their lives are worth living. Suicide is not a medical procedure, and doctors have no special expertise to determine when it is the right choice.

    Who, exactly, has the expertise to determine that it is the right choice?

    Many of the people who want to attempt suicide wouldn't be legally allowed to purchase a gun or a sign a contract based on their mental competence. If we restrict those actions--to which there is a clearly established right recognized by law--why shouldn't we restrict the freedom to dump your carcass and responsibilities onto the rest of society.

  • MNG||

    "Many of the people who want to attempt suicide wouldn't be legally allowed to purchase a gun or a sign a contract based on their mental competence."

    Where did you get that from?

  • Realist||

    "Many of the people who want to attempt suicide wouldn't be legally allowed to purchase a gun or a sign a contract based on their mental competence."
    Only a real fucking idiot would want to ATTEMPt suicide!

  • ||

    In a number of states being suicidal (or other people claiming you're suicidal) is considered grounds for stripping you of your firearms rights. I personally know psychiatrists and psych nurses who consider even owning a gun as ipso facto evidence of mental instability, so it's not hard for them to write down a recommendation to a judge that they feel that somebody is a danger to themselves and thus must be controlled.

  • nicole||

    the freedom to dump your carcass and responsibilities onto the rest of society.

    Or that?

  • J[o]h[nn]y L[o][n]gt[o]rs[o]||

    Who, exactly, has the expertise to determine that it is the right choice?

    Obama, or someone appointed by Him.

  • ||

    we obviously need a real death panel to determine who is fit to commit suicide - staffed by Top. Men. who all earn big money and benefits off of the government teat.

  • Weiner||

    I know how to kill a career and I might be looking for work

  • Realist||

    Get in line!

  • MNG||

    This should be a fundamental issue for libertarians. Why should the government step in between a consenting doctor selling this as a service and a consenting patient who wants it? Nothing is more fundamental than this choice.

  • Joe M||

    Obviously, suicide should not be illegal, nor should either selling products like this, drugs, or assistance services. But kits like what Hydorn sold are extremely easy ways to go out. You don't get the sensation of suffocation because there is no build up of carbon dioxide in your lungs. I've seen similar kits that use nitrogen instead. Essentially, it's like dying in your sleep, since you black out first.

  • MNG||

    Wouldn't going easy be a feature, not a bug, for a person who has made that choice?

  • Joe M||

    Absolutely. Wow, did my comment sound like I was arguing against such kits? I totally favor them precisely because they make it so easy and painless. It's an extremely difficult decision; it shouldn't also be a source of actual physical suffering at the crucial moment.

  • Some Call Me. . .Tim||

    What do you mean by "black out"?

  • Joe M||

    Lack of oxygen leading to syncope, fainting, passing out, loss of consciousness, etc. You aren't awake at the moment of death.

  • WTF||

    OT - This is awesome, apparently, the cops can bust into your house on a tip from a psychic.

  • MNG||

    Whims from a cop, not probable cause (at least in theory), whim from a quack, just fine.

  • sarcasmic||

    If you don't have thousands of dollars on hand to pay a lawyer to sue the department, whims from a cop are just fine.

  • MNG||

    I hope you oppose recent tort reform efforts like loser pays.

  • sarcasmic||

    What does that have to do with anything?

  • MNG||

    Loser pays means less lawyers will take cases for poor clients.

  • Joe M||

    Actually, I think it means less lawyers will take poor cases for clients.

  • sarcasmic||

    "Loser pays means less lawyers will take cases for poor clients."

    Loser pays means lawyers will be less likely to take on frivolous lawsuits, and John Edwards would never have gotten rich.

    It also means that poor clients with a good case would have better access to lawyers than they do now.

  • Realist||

    Loser pays means more lawyers will starve to death.....this is always a good thing!

  • ||

    ACK! I hate when you plebs throw the word frivilous around like you even understand legal speak. Frivilous means there is no chance in hell the lawsuit has merit. On at least 2 occasions, courts of law allowed his cases to go to trial and both times he won multi-million dollar verdicts. If you don't like the law, tell the legislature to overrule these horrible fucking precedents. The only thing loser pays will do is discourage lawyers to take chances expanding the law with judges, i.e. former lawyers, all too eager to please.

  • Another Psychic||

    information provided by the anonymous female tipster about the property was very specific and accurate. He said authorities would attempt to find the tipster and question her.

    I know where she is.

  • Authorities||

    We'll attempt to find you.

  • Another Psychic|||

    Don't bother, I am pschic and know where you are looking.

  • Another Psychic|||

    ...or psychic...

  • ||

    "It's somewhere near a body of water. There's a field. And some woods." [/psychic schtick]

  • Joe M||

    Could be inside or near a building.

  • ||

    Ah, yes, that well known psychic powers exception to the Fourth Amendment.

    Sigh. Thugs in uniform, tyrants in black robes, and the superstitious idiots that enable them.

  • WTF||

    Exactly - how the hell does a judge actually think it's okay to sign off on a warrant based on a 'psychic'?

  • Wind Rider||

    He consulted his Ouija board, it told him it was ok.

  • Judge||

    Nah - Magic 8-ball, ouija board is too much work.

  • Some Call Me. . .Tim||

    Wait, this was a Kurt Russel movie.

  • Realist||

    The judge is psychic and knew the psychic knew.

  • Gray Ghost||

    As this story is in my 'neck of the woods (pun definitely intended), the following linked story provides a bit more information. http://www.chron.com/disp/stor.....99979.html

    Basically, it seems the phoned-in tip prompted officers to pay a visit to the property. Once there:

    "After a cursory search of the residential property outside of Hardin piqued officers' interest with signs of blood and an awful smell, other Texas and federal agencies were brought in to assist what had the potential to be a horrendous mass killing. The tipster claimed there was a grave there with two dozen or more dismembered bodies, including those of children, but an exhaustive search later Tuesday proved pointless: The blood came from a weeks-old incident and the odor was a pile of rotting meat in a non-functioning deep freezer."

    A relative of the homeowner cut himself severely on the porch of the home, leaving blood all over the place. Said relative is now in a rubber room at Fort Hood. Why the homeowner didn't clean up the blood after all this time, I couldn't say. Also, while you have to admire the homeowner's sardonic sense of humor, quotes like the following probably didn't help his case:

    "Finding out that the police are in my yard for dead bodies? That's kinda panicking me. I ain't killed nobody. We've had the cops out at our house, but never for nothing like that. Somebody called the police on my dogs one time."
    "I haven't killed anybody," he said. "And I have a lot of friends, but I haven't helped anybody bury any bodies."

    Probably one of those times where humor sounds better live than it looks in print.

  • LarryA||

    Probably one of those times where humor sounds better live than it looks in print.

    Or while looking at the wrong end of a gun.

  • Irwin Mainway||

    Hydorn was doomed to fail anyway. $60 for a plastic bag and a rubber tube? You can't make a profit that way. My Snuff-It-Tron is $15 plus postage and my profit margin is way higher.

  • Some Call Me. . .Tim||

    But will snuff-it-tron work on tough household stains?

  • Joe M||

    You'll never have to worry about stains again.

  • ||

    LOL Joe! Man, you guys are brilliant. I love this place.

  • Irwin Mainway||

    Snuff-It-Tron will even make your wife stop nagging.

  • Donald Duck||

    Or make you talk like me?

  • Irwin Mainway||

    Snuff-It-Tron has no unpleasant side effects.

  • Louie||

    That's a bunch of Huey.

  • Yuno Hoo||

    I cope via the easily-available remedy Damitol or extra-strength Fukitol.

  • J[o]h[nn]y L[o][n]gt[o]rs[o]||

    Off to work. Late Morning Links means no GG for you.

  • Yuno Hoo||

    Damitol!

  • Some Call Me. . .Tim||

    Come back Shane. Come back.

  • mr simple||

    Is this why they've been getting posted later and later?

  • ||

    I'm fine with people having autonomy over their lives to the extent that if they want to end it, they can do so.

    I'm against anyone else taking a life, whether it's just plain murder, physician-assisted suicide, or some entrepreneur selling by mail order the means to kill one's self.

    Come to think of it, the last example seems most consistent with libertarian principles than the first two.

  • tarran||

    Wow, so firearms should be outlawed?

  • CJ||

    And kitchen knives.

  • Concerned Citizen||

    A buddy of mine offed himself a month ago. Of course it was his life and his choice to end it, but it still sucks. As it has been said before, at least in his case, suicide is a permanent solution to a temporary problem.

  • GroundTruth||

    It sucks royally for friends and family. But there are also cases where suicide is a reasonable solution to an immense and permanent problem... and a plastic bag full of helium beats the hell out of a stomach full of Drano.

  • Juice||

    Do-It-Yourself Suicide

    Isn't that redundant?

  • LarryA||

    Do-It-Yourself Suicide. Isn't that redundant?

    There's suicide by cop, stepping in front of a semi, staging an active shooting at an NRA convention, etc.

  • Robert||

    I used to be in medical device R&D, and it's funny to think about this case, because, yep, technically that's what the article for sale is, a medical device. (It's not a pesticide, which would put it under EPA, because IIRC euthanasia devices for animals are not considered such.) Read the statutory definition and there's no other conclusion you could come to. If it's not meant to affect the function of the human body, I have no idea what is!

    She could file a 510(k) registration to introduce it legally into interstate commerce (and to be legally marketed according to her state's board of health or pharmacy board), but it's hard to figure out what classification to put it in or what the application would have to be. The easiest registrations are for class 2 devices, which are to be shown to be "substantially equivalent" to other medical devices already legally marketed. I don't know whether there could be found such an equivalency -- you'd be amazed sometimes -- but it would practically always turn out to be a prescription medical device, and so require a prescription as well. However, it would probably be a class 3 device because of the substantial "risk" of death from using it. That's a difficult filing, like a new drug application, and would undoubtedly result in the device's requiring a prescription anyway, and now possibly instructions specifying it be used only by specialists trained in its use!

  • ||

    what if the user had to assemble the product?

    I remember in the 80s when my HS friend bought a "switch-blade kit". Owning a swtich-blade was apparently illegal, but selling the parts wasn't.

    Yes, I knew all the freaks.

  • Robert||

    An article intended as a component of a "[medical] device" is a "[medical] device", per the statutory definition.

  • EscapedWestOfTheBigMuddy||

    because, yep, technically that's what the article for sale is, a medical device [...] Read the statutory definition and there's no other conclusion you could come to

    I'll take your word for it, but all that proves is that the statutory definition is a load of hooey.

    Basic timeline:
    ----------
    1. There exists a concept. It might be tough to nail down the exact edges, but people are largely in agreement about where it definitely does and does not apply.
    2. Bureaucrats attempt to formalize the concept. In order to to insure no one weasels out of their control they write a hugely general definition or in order to limit the scope of their responsibility they write a tightly constrained definition.
    3. People take the definition more seriously than the underling concept.

    See also "the people fleeing the Big Easy after Katrina aren't refugees (i.e. people seeking refuge) 'cause the UN defines that word as people coming to other countries".

    This seems to be one of the unwanted side-effects of civilization and I don't imagine that it can be put to rest, but there is no reason (drink!) not to fight the good fight.

  • Robert||

    In the case of the food & drug laws, most of the important definitions have been construed more narrowly than a literal reading would seem to require. Otherwise clothes would be "cosmetics" and art, literature, etc. would be medical devices.

    This is why there's been wrangling over whether tobacco products are "intended to affect...any function of the body...of man or other animal". Most of the time, FDA and state pharmacy boards have acted as if recreational psychoactives are excluded from consideration as "drugs" or "devices". Originally the definition was only to cover disease-related and injury-related articles, i.e. stuff that was intended as curative, palliative, or diagnostic. But then Congress and the states wanted to take in diet pills under their jurisdiction. A proposal was made to simply include language to cover just them, but instead they wound up adopting the ridiculously expansive language we see today, which, however, cannot be taken literally.

    If you really want to get into this, an interesting tidbit is the exemption in the definition of "cosmetic" for "soap". Congress had a few qualifiers in earlier drafts that got amended out as to what "soap" meant. Eventually, years later, FDA wound up formulating their own definition of "soap" which was a narrow, technical one that was probably not the layman's (or Congress's) understanding.

  • ||

    [, technically that's what the article for sale is, a medical device.]

    And they've always been for sale over the counter, short waiting period in some locations. Available in .22, .380, .40, .44. .45, 9mm and some even come with "magnum" settings. Very efficient. Grow a nut sack and get on with it and stfu.

  • Johnny and Mike||

    ...but it is painles.

  • ||

    To me, there's negligible moral difference between killing oneself and killing another person. If I kill myself today, the outcome would be no different for me than it would if a serial killer did it. But it's the same level of tragedy for the people who knew me. Society discourages suicide because it's so cruel to loved ones.

  • Jim||

    One action is voluntary, and the other is not?

  • ||

    Religious conversions, marrying the "wrong" race/gender, and joining the military can all be "cruel to loved ones".

  • The Derider||

    "That stance may sound cautious and compassionate, but it effectively strips people of the autonomy to decide for themselves when their lives are worth living."

    Depression effectively strips people of the autonomy to decide for themselves when their lives are worth living.

    Mental disorders are real, and sometimes make their victim irrational.

  • Jim||

    Problem being, there's not a blood test or an x-ray that can be done to positively determine at which point a person is "depressed" enough to lose autonomy. If you believe the mental health professional associations, something like 50% of all Americans have some form of "mental illness".

  • ||

    There are many that believe that it is simply not possible for a person to make a rational decision to take their own life, ever.

    Some of them believe this for secular and some for religious reasons, but regardless of why they believe they always know better than other people about themselves, they're working in hospitals and courts and have real power.

  • ||

    Potassium chloride, not sodium chloride.

  • ||

    "Suicide is not a medical procedure, and doctors have no special expertise to determine when it is the right choice"

    Sort of. Doctors have a number of skills and experiences in this area that others may not:

    1) They have a better idea than most about a person's prognosis, about whether a medical condition will improve, decline, remain the same, etc.

    2) They may have more insight into how the condition will affect a person's quality of life as in many cases they will have seen other patients in a similar condition.

    3) They can get suicide right, i.e. make it painless and ensure that it results in death, rather than an increased level of disability or pain stemming from a botched attempt

  • Ben ||

    I'm pretty sure it's potassium chloride. NaCL is table salt.

  • Realist||

    Yes, KCl.

  • M||

    Start with the reality that, if you're suffering from a terminal or nonterminal but chronic, painful and substantially life changing illness, you would, virtually by definition, be depressed; who decides if your depressed state is a reasonable response to your situation, or is excessive, and interfering with your ability to make rational decisions? Especially when most actions, positive and negative, are not (at least, not alone) the result of purely rational decisions.

  • Pandora UK||

    Some of them believe this for secular and some for religious reasons, but regardless of why they believe they always know better than other people about themselves, they're working in hospitals and courts and have real power.

  • nike dunk||

    is good

  • goallen||

    I am an aspiring architect and I am appalled

  • easyout||

    Can a medical person expound on the relative merits of inert gas (helium) versus bio active gas (carbon monoxide) in quickly and painlessly ending life. Want to be prepared.

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