Physician-Assisted Death Gets a Second Look in a Post-Kevorkian Era

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September 25, 2014

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The Assisted Death Movement Gains Support

After many years of no movement at all, physicians may have to contend with the controversial end-of-life option of physician-assisted suicide. Also known as "physician-assisted death" (PAD), it involves helping terminally ill patients die rather than face excruciating pain and loss of dignity.

For more than a decade, from 1997 to 2008, Oregon was the only state to allow physician-assisted death. But in recent years, Washington, Montana, and Vermont have legalized PAD, and the Canadian province of Quebec did so in April.

Physicians, who have to carry out PAD, are significantly less enthusiastic about it than the general public. A recent study[1] shows that more than two thirds of physicians oppose PAD, but according to a new Gallup poll,[2] most Americans support it. 

James C. Salwitz, MD, an oncologist in East Brunswick, New Jersey, opposes PAD but is convinced that the state legislature will approve it in the next few years. In this legislative session, a PAD bill was reported for the first time out of committee, and although he doesn't think it will pass this year, he does think it will pass eventually. "The interest in this is building," said Dr Salwitz, who has been going around the state debating the issue with PAD proponents in front of senior and religious groups.

The reemergence of PAD may have something to do with the disappearance of the one person most responsible for putting it in front of the American people. Jack Kevorkian, MD, who died three years ago, is remembered as a highly divisive figure. In his heyday in the 1990s, 140 people expired on his "death machine," which was loaded with a lethal dose of drugs. He even appeared on the cover of Time magazine as "Dr Death" in 1993.

Dr Kevorkian was part serious crusader and part showman. In a 60 Minutes segment that aired in November 1998, he personally administered a lethal dose to a patient, violating his own rule that the patient should pull the lever. For this incident, he was found guilty of second-degree murder and imprisoned for eight years.

Many PAD advocates think that Dr Kevorkian did a disservice to the movement. Timothy Quill, MD, director of the Palliative Care Program at the University of Rochester School of Medicine, was the chief plaintiff in a lawsuit challenging the constitutionality of state laws against PAD. It was Dr Quill's lawsuit that prompted the Supreme Court in 1997 to uphold the PAD prohibitions, allowing each state to set its own policy.[3]

Dr Kevorkian "did bring the issue out of the closet and into the open," Dr Quill said, "but he was a real wild card, and he became an easy target for the opposition to point to." Asked whether the recent spate of PAD legalizations might be connected to Dr Kevorkian's exit from the national stage, Dr Quill said, "There's a grain of truth to that."

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