Killing Kindness

Jack Kevorkian believes we can solve moral problems by medicalizing them.

The act of killing may be deemed good or bad, depending on who kills whom and why. When a man shoots an intruder about to attack him, we condone the killing as self-defense. When a bandit shoots a bank teller, we condemn the killing as murder. However, when a person kills himself, we are confused about whether to regard his act as good or bad and instead classify it as mad.

Although priests no longer consider suicide a mortal sin, and lawmakers do not punish it as an offense against the state and hence a crime, psychiatrists now diagnose it as a symptom of a mental illness and hence incarcerate the unsuccessful or would-be suicide as a "dangerous" mental patient. Regardless of our moral judgment of the act, suicide is by definition a type of homicide. Like any homicide, we may judge suicide to be justified or unjustified, virtuous or wicked, sane or insane, depending on the circumstances and on our own values.

It is against this background that we must view Dr. Jack Kevorkian's crusade for physician-assisted suicide as a state-approved "right" and "treatment." Since Kevorkian's recent announcement that he has abandoned his campaign of law defiance, and instead has undertaken a campaign of "law reform," he is more dangerous than ever. His aim is ominous because it taps into one of our most powerful popular delusions, namely the belief that we can solve moral problems by medicalizing them. Maintaining that the so-called right (of a terminally ill patient) to physician-assisted suicide is more fundamental than our established constitutional rights, Kevorkian wants it encoded in the constitution of the state of Michigan. And because this right is, in fact, a service, he wants it guaranteed–that is, provided–by expanding the medical profession's legally recognized repertoire of treatments to include doctors helping patients to commit suicide.

To grasp the threat of Kevorkian's purported compassion and the seemingly widespread popular support for it, it is necessary to remember the long history of medicine's war on freedom and self-determination. In Plato's Republic, he explained "that our rulers will have to make considerable use of falsehood and deception for the benefit of their subjects. We said, I believe, that the use of that sort of thing was in the category of medicine."

Before approving physician-assisted suicide as a treatment, we need to confront the ethical challenge of suicide itself. As matters stand, suicide is in a moral-legal limbo. It is a right: The act is not prohibited by the criminal law. It is not a right: Expressing the intention to commit suicide or attempting to do so is prohibited and punished by the mental-health laws (by psychiatric incarceration and involuntary "treatment"). In other words, suicide is a right in principle, but not in practice: The "right" is annulled by mental illness, a condition now attributed virtually automatically to the suicidal person as well as the successful suicide (which is why he is no longer refused religious burial in consecrated ground).

Next, we must distinguish between a person's assertion that he wants to die and the act of ending one's life. Speech is richly nuanced, especially in emotionally charged situations. In the final analysis, actions alone count. Unless a person kills himself–by his own hand, preferably alone–we cannot be certain he wanted to die. The potential abuses of a tax-supported service of physician-assisted suicide–especially for old people–are too obvious to require detailing.

Finally, we must decide whether we want to retain or reject the time-honored moral principle that the physician, qua physician, should not kill or assist in killing another person. If abstaining from such behavior–like abstaining from having sex with patients, except more so–is an integral part of the physician's role, then physician-assisted suicide is a contradiction in terms. On the other hand, if such behavior is deemed permissible or even praiseworthy–because of the patient's consent or request–then it is not unreasonable to entrust doctors with the task of assisting persons who want to kill themselves.

It is important to keep in mind in this connection that Kevorkian rejects the view that suicide is a basic human right. He believes that suicide is justifiable only when a person experiences intense suffering caused by a fatal illness, both the nature of the illness and the severity of the suffering being judged by the doctor. Even then, Kevorkian does not support the sufferer's right to kill himself–say, by having access to lethal drugs. Instead, he advocates giving doctors the professional privilege–and, by implication, the professional duty–to help persons kill themselves.

But the fact is that neither killing another, nor killing oneself, nor helping a person kill himself requires medical expertise. Giving a person a drug to help him commit suicide is like giving him liquor to help him become drunk. Actually, Kevorkian's proposed practice of "medicide" closely resembles the execution of a death-row inmate by lethal injection. Both interventions depend on the use of drugs, the main difference between them being that one form of drugging is carried out with the subject's consent (ergo, it is a treatment), and the other is carried out without his consent or against his will (ergo, it is a punishment).

Although this is an important distinction, it does nothing to resolve our dilemma. The desperate plea of a person in pain, deprived by drug laws of adequate analgesics, is a poor imitation of consent. Conversely, an individual may commit a capital crime because he wants his life to end, may not experience death as a punishment, and may request execution. Moreover, we accept treatment without consent as legally proper (typically in psychiatry), and we do not accept consent as sufficient justification for transforming an ordinary act (such as sexual intercourse) into a medical treatment.

Judging by the published reports, the persons whom Kevorkian has "assisted" could have ingested a fatal dose of a lethal drug, had they had access to such a drug and the courage to use it. The fact that drugs useful for committing suicide are now available by prescription only is a cultural-legal artifact. Prior to 1914, lethal drugs, like other consumer products, were available in the free market. Not by coincidence, suicide was then considered to be the act of a moral agent, not a symptom of a mental disorder or a treatment for an agonizing illness.

Kevorkian deserves credit for his candor: He wants physician-assisted suicide to be a new medical specialty, "medicide." This gauche neologism should serve as a warning. Terms such as herbicide, insecticide, and infanticide illustrate the linguistic rule that, by adding to a noun the Latin suffix -cide, we identify the living thing killed. Medicide therefore means "killing doctors" or "killing medicine" (in Latin, doctor is medicus, and medicine is medicina). Nomen est omen.

Contributing Editor Thomas Szasz, professor of psychiatry emeritus at the SUNY Health Science Center in Syracuse, New York, is the author of numerous works on drug and mental-health policy. His forthcoming book is Cruel Compassion (Wiley).