The Post-Kevorkian Era

Barbara A. Olevitch
The Jewish Press
October 18, 2011
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Jack Kevorkian, who helped over 130 people to commit suicide, died on June 3, 2011.  The suicide contraptions that made him famous also enabled him to evade prosecution - as long as it was the victim who actually pushed the button.  For example, he inserted an intravenous line containing a harmless saline solution into Janet Adkins, his first victim.  However, when she pushed the button, a lethal combination of drugs was injected into her instead of the saline.  Kevorkian's idea of facilitating death without actively bringing it about is still very much alive today.
 
How was he able to attract so many victims - many of whom were not even terminally ill? Why did Janet Adkins, a 54-year-old woman who was still physically fit and only beginning to notice the first signs of impairment from Alzheimer's, jump at the chance to become Kevorkian's first victim soon after her diagnosis? Simple: Adkin's was a member of the Hemlock Society, an organization that promotes the "right to die."  She was actually acting on her most sincere belief.
 
Wesley J. Smith, author of Forced Exit: The Slippery Slope from Assisted Suicide to Legalized Murder, found a copy of the Hemlock Society's publication, the Hemlock Quarterly,in the files of a friend of his who had committed suicide.  The copy had been heavily highlighted and "dog-eared from frequent reading."  Reading the newsletter, with its glowing descriptions of "peaceful" suicides, cleared up the mystery that he had been wondering about - where had his friend learned "the euphemisms for self-destruction that sprinkled her vocabulary, such as 'deliverance' and 'final passage'?" 
Suicide advocacy groups such as the Hemlock Society have been working feverishly to make the idea of assisted suicide more acceptable to mainstream America.  This is something that Kevorkian, with his misadventures with the law, such as provocatively dropping off bodies at various places, could never do.  For example, in September of 2000, a public television special called "On Our Own Terms" was coordinated with an outreach campaign dealing sympathetically with assisted suicide.  There were local programs taking calls from viewers, town meetings and discussion groups. Other events like this have been sponsored by George Soros' Project on Death in America and the Robert Wood Johnson Foundation. 
 
Efforts to legalize lethal medication have largely failed (In Washington and Oregon the measures were approved in statewide referendum, in Montana by court decision), but another method of hastening death has been rendered very acceptable in America.  In 1993, an article appeared in the Archives of Internal Medicine.  The authors argued that "Patient Refusal of Hydration and Nutrition," which they abbreviated as PRHN (also called PRNH), could be used as a way of achieving the same goals as physician-assisted suicide and that this option should be widely publicized.
 
On July 24, 2003, an article appeared in The New England Journal of Medicineauthored by Linda Ganzini and her colleagues at the Oregon Health Sciences University.  It was a survey taken of the opinion of hospice nurses who were asked whether their patients, who had chosen deliberate starvation and dehydration, had had comfortable deaths or not. This tabulation of the guesses of hospice nurses about the inner feelings of their patients wasfeatured in newspapers across the country as if it was a great scientific discovery proving that starving patients are truly comfortable. PRHN, also called VSED (voluntary stopping of eating and drinking) has become a popular palliative care option.
 
Not content with popularizing a legal method of hastening death, advocates of assisted suicide are now seeking to marginalize those who do not approve of it.  In 2002, the authors of the article on patient refusal of nutrition and hydration wrote a letter in the Annals of Internal Medicine stating that physicians "should not impose their own religiously based moral views on patients by refusing to inform them of their legally sanctioned options."
 
Unbelievably, laws are now being written that requires doctors to offer information about all legal palliative care options to their patients.  In September 2008, the "Terminal Patients' Right to Know End-of-Life Options Act" was passed in California.  A doctor can now provide end of life option information upon request, refer the patient to another provider or he can utilize "fact sheets and Internet Web sites" from "organizations specializing in end-of-life care." Guess which organization is ready and waiting to provide this information?  The Hemlock Society merged with another organization and is now called Compassion and Choices.  They advocate for "aid in dying," "end-of-life choice," or "death with dignity," and specialize in distributing information about end-of-life options.
 
The California statute aims to protect the public from those doctors who are influenced by "cultural and religious pressures" and who "object to certain practices" and don't "believe that they have an obligation to present all of the options to patients."  The Act warns that this can result in "bad deaths" that cause "needless physical and psychological suffering."
 
Compassion and Choices actually drafted New York's new legislation, called the Palliative Care Information Act, which was passed in August 2010, threatening doctors with fines and possibly even jail sentences if they do not offer palliative care information to all patients diagnosed with terminal diseases.
 
It is important to be aware that over the last number of years, the category of terminal illness has been vastly expanded - it is not just advanced cancer.
 
New terminal diagnoses are being defined and are treated with great seriousness, as if they were classical disease entities that had troubled mankind since ancient times.  For example, a diagnosis that used to be applied to infants is now being applied in geriatrics.  It is called "failure to thrive" (FTT) or "adult failure to thrive" (AFTT).  A quote attributed to the National Institute of Aging described FTT as a "syndrome of weight loss, decreased appetite and poor nutrition and inactivity, often accompanied by dehydration, depressive symptoms, impaired immune function and low cholesterol."
 
The traditional medical approach to a patient with these symptoms is to look for dehydration, malnutrition, depression, electrolyte imbalances, medication overdoses, etc. As Dr. Allen Lempel explained at the November conference of Agudath Israel, this type of routine medical care can sometimes reverse the patient's decline.  However, the new definition of the AFTT syndrome leads the practitioner in a different direction.  By giving this syndrome a name and calling it "terminal," large numbers of patients who would have previously been ineligible for hospice because they lacked a terminal disease have now become eligible.
 
If a patient were diagnosed with dehydration, a Jewish family would know that they should ask for fluids.  But what about if their loved one is diagnosed with a mysterious new syndrome called AFTT and they are told this is a "final pathway" to death?  This is very confusing.
 
Torah-observant families (and their rabbis) seeking medical care for their loved ones can benefit from expert help.  They cannot be expected to keep up with all the new vocabulary that advocates of hastened death keep generating.  In order to attain clarity in this strange Post-Kevorkian era that we live in, we need to enhance the accessibility of Jewish experts in the area of health care for the seriously ill.  I hesitate to call it the "end of life" area, because, in so many cases, it isn'treally the end of life.
 
 Agudath Israel of America has recently established Chayim Aruchim, a Center for Culturally Sensitive End-of-Life Advocacy and Counseling.  Here patients, families, rabbis, doctors and other health professionals can get rabbinic, legal and medical help all in one place - from those who are experienced in dealing with these very complicated situations. Does a patient need a lawyer to get his hospital to provide treatments required by Jewish law?  Are there curative options the patient has not been told about?  Are there health care facilities where he could get what he needs without sacrificing his religious principles? These are the kinds of questions Chayim Aruchim is aiming to answer. 
 

Patients and families can reach Chayim Aruchim at (718) 535-9061. The New York State Project Director is Rabbi Aron Wajsfeld.  The halachic advisor is Rabbi Zvi Ausch, and the legal advisor is Mordechai Biser, Esq. May they succeed in saving lives!

 

 

Barbara A. Olevitch, Ph.D., is a clinical psychologist living in St. Louis, Missouri and author of Life is A Treasure: The Jewish Way of Coping with Illness (Targum Press), a book of chizuk for patients, families and friends.