PERSPECTIVE ON THE ‘RIGHT TO DIE’ : Patients, Doctors Are Too Busy Denying Death to Rush Into Suicide : Even if assisted suicide were made a right, it would have a minimal impact on the lives of the sick and infirm.


Dr. Jack Kevorkian’s bold act of assisting the suicide of a woman diagnosed as having Alzheimer’s disease has re-sparked an age old controversy in law, medicine and ethics.

Should competent people be allowed to commit suicide at all? Should others be allowed to help them? Questions like these will beguile talk-show hosts and delight philosophers for many years to come. But such questions, however potent as news titillation, are ultimately trivial.

The simple truth is that it is easy to commit suicide. Yet few people do it and those who do almost never have a terminal illness. Accordingly, even if assisted suicide were made a right, it would have a minimal impact on the lives of sick and infirm Americans.

Why don’t the painfully ill commit suicide? Some argue that it’s because of the fear of the unknown, the anticipated sadness of solitude and separation and the terror of no longer being. This reasoned view aggrandizes the typical patient. Actually, medically motivated suicide is rare because patients are co-conspirators with their physicians in the denial of death.


The Grim Reaper does not announce his arrival. Death does not stand before you and declare: “This is it. This is the illness or downturn that will kill you. From here on out your course will be inevitably downward, with misery and suffering far outweighing the few moments of pleasure. I demand that you surrender.”

Although modern physicians are more enlightened about the importance of communication with their patients, their training makes it difficult to prompt a real existential moment--a sober moment of choice. Besides, in-depth humanistic contact is not a billable procedure. Doctors understand that science is statistical. It is hard for them to say that death is certain. The internist wouldn’t dare announce that the pain and degradation of suffering through the onslaught of a cancer’s next move just isn’t worth it.

Of course, the physician’s denial of choice is aided by both the patient and the family being infected with hope and distracted by the minuscule ups and downs of the disease. “He’s looking so much better today.” “I understand she’ll be able to go back to the nursing home tomorrow.” Doctor, patient and family all rivet their eyes on the day-to-day perturbations in pain and disability, ensuring that their gaze will not fall, even momentarily, on the future. We gracefully, albeit surreptitiously, substitute little choices for the big choice. Inso doing we escape the Angst of any real choice. Using this denial, healthy family members also are freed from the guilt they feel because they are haunted by an unconscious voice that says: “I can’t take this any more. I wish he’d die.”

Finally, after weeks, months or even years, the patient returns for his final hospitalization. Death’s presence is now undeniable. The feeding tubes are in, every aspect of the patient’s bodily functions is being regulated by medications or machines. And the opportunity for the patient to make a choice is then denied because he is unconscious or delirious. At this point, assuming an enlightened physician, it is the doctor and the family who will face the choices. Having postponed confrontation, surrender will be easier. Paradoxically, under this common scenario, we only get to choose death for others, our relatives, but never for ourselves.


The questions our culture must face now is: How can we treat death with dignity instead of denial? Why have we developed such a terrorizing myth about death? Why have we built a medical Establishment that robotically struggles against death without stopping for a moment and asking if the fight is worth it? Until we understand that death, or the continuation of life, is a choice that we must make, then consideration of our right to die is premature.

Unfortunately, thinking philosophically about life has become passe. Indeed, it has been almost 50 years since there has been significant thinking by philosophers about death. While religion still plays some role in the life of many Americans, it is typically social, sterile, formalistic and, most important, devoid of any guidance on the tough questions of terminal illness and choice. While our reverence for the MBA and economic pundits has produced a quantum leap in our financial capacities, our philosopher’s soul has atrophied and we are unable to tackle the really tough questions. Sadly, the choices about death in the terminally ill may be made by economists because the bulk of public-health dollars are spent in the last six months of patients’ lives.

Dr. Kevorkian will excite our curiosity. For a few weeks, maybe even months if he’s charged with a crime, he’ll travel the talk-show circuit and we’ll contemplate whether he should be strung up from the nearest tree. Then, in a few months, some other piece of dazzle will capture our attention.

Until we examine and speak about the death wish in a more somber light, we are destined to be left feeling a little empty. There must be a way to move against the tidal forces of trivia and sparkle that dominate the media and our educational institutions.