Jack Kevorkian is not alone.
Here in the Northwest, quietly, without television cameras or heated public rallies--and so far without interference from authorities--determined activists are helping extend the frontiers of assisted suicide for the terminally ill.
Compassion in Dying is the name the group of 25 volunteers and 1,400 financial backers has given itself. And so far it has lent encouragement, counsel and support to dozens of men and women who sought help in ending their lives in the final stages of disease.
Maybe more significantly, the group is proceeding with court action asking a federal judge to declare a constitutional right for Americans to hasten their inevitable deaths.
“Things are changing in the country,” said Susan J. Dunshee, board president of the group. “More and more people know someone who is terminally ill. Pretty soon, almost everybody is going to know someone who has AIDS. There is more about end-of-life issues on television. More books on the subject. More in the newspapers. It’s not the same anymore.”
Indeed, while suicide remains stigmatized and assisting in suicides is unlawful in more than half of the states, it is an everyday fact of life across much of the nation.
But it occurs in a forbidden zone of American culture--with knowing but uninvolved doctors, amateur how-to guidebooks, AIDS- or cancer-support groups, perhaps a loving partner or family member. Or worse, it occurs violently, with a gunshot or a car wreck.
Lacking is public acceptance. And uniform standards, reliable guidance, medical recognition and a solemn process or ritual.
Members of Compassion in Dying say they find this a cruel indignity for people who have suffered greatly. And so the group has stepped into the legal “gray zone,” willing to help the dying--up to a point--and simultaneously nudging society toward lifting this taboo.
So, what does Compassion in Dying actually do?
Dunshee says the organization will only assist adults whose doctors attest that they have a terminal illness and less than six months to live. Patients are screened for mental competence and to make sure that no close friend or relative will object to suicide counseling.
At that point, it is up to the dying patient to procure enough barbiturates from a physician to enable suicide.
In this regard, Compassion in Dying is different from Kevorkian, the former physician in Michigan who has provided the means for suicide. Also, Kevorkian has not limited his assistance to people with less than six months to live.
Kathryn L. Tucker, an attorney who advises Compassion in Dying, says the process by which a patient must obtain suicide dosages of drugs is unsatisfactory. She described a typical encounter between doctor and patient:
Patient: I’m having a terrible time sleeping.
Doctor: OK, I’ll give you a prescription. But don’t take more than “X” because it will kill you.
“They talk in that kind of code. They don’t have direct communication. There is no opportunity for doctors to consult one another like they do on everything else. Yet these are people who critically need medical advice,” Tucker said.
With that dialogue lacking, Compassion in Dying will counsel patients about dosages, how to mix the barbiturates with soft food, about anti-nausea treatment and how to follow up the mixture with a shot of whiskey. In all cases, the organization says the patient must self-administer the drugs. Sleep follows in minutes, death within hours.
“It’s a tragedy for people who think they know how to do this and then botch it,” Dunshee said. She also said it is a “tragedy” that a good many patients turn to their doctors and are refused barbiturate prescriptions in sufficient quantities.
About half of the terminally ill who contact the group have cancer, closely followed by AIDS and, a distant third, emphysema. Dunshee said several hundred ill people have made contact with the group and about 30 have followed through with the organization until their deaths, either by suicide or from the effects of disease before a suicide could be undertaken.
By reaching out to Compassion in Dying, patients and families are seeking more than just guidance. They are grasping for social validity for the decision to end a life.
Some ask for more. They seek spiritual counseling. Ralph Mero, executive director of the group, is an ordained minister--and the organization calls upon a network of volunteer clergy from many religious denominations.
Some patients ask that Compassion in Dying volunteers be at their bedsides at the end. The organization honors these requests, although it is vague about how many suicides its volunteers have attended--probably fewer than 10.
“This makes it possible for some people to die in their own beds with dignity. Nobody should have to die alone,” Dunshee said.
To avoid legal problems, Dunshee won’t directly acknowledge witnessing a suicide. She will say only that she has been on hand when a person died at the time of his own choosing.
“I had the sense that this was the best possible death. A person is conscious before dying, surrounded by loved ones, in his own bed with his favorite music.”
When asked, the Roman Catholic Archdiocese of Seattle and well-known right-to-life organizations in the state will denounce Compassion in Dying. But so far, the backlash has been temperate.
The practice of assisting in suicides is more widespread than some might think. Less than a year ago, the 145,000-member National Assn. of Social Workers issued guidelines saying it is “not inappropriate for a social worker” to be present at a suicide. Crusader Derek Humphry’s book on the subject, “Final Exit,” has sold more than 700,000 copies.
Tom Preston, a Seattle cardiologist and advisory board member to Compassion in Dying, guesses that between 30% and 50% of the doctors he knows would be willing to prescribe barbiturates for terminally ill patients. He has long advocated revising medical standards to help people avoid terrible suffering just before death.
“At the end of life, there is a clash between the two callings of medicine--prolonging life and easing suffering. Today there are too many physicians using curative methods for people who are dying. These are intrusive, painful and cause distress. Part of the role of the physician is to help people die,” Preston said.
Compassion in Dying is an outgrowth of a 1991 Washington state ballot proposition that sought to legalize physician-assisted suicide for terminally ill, mentally competent adults.
The measure was favored in pre-election polls but went down to defeat after opponents mounted a campaign suggesting that physicians would become killers.
A similar proposition was defeated in California in November, 1992.
In the aftermath of those defeats, organizers in Seattle decided to make their next big push in the federal courts. Like many states, Washington has a law making it a crime to assist or cause a suicide.
In a lawsuit argued recently in U.S. District Court here, Compassion in Dying and a string of supporters argued that such laws violate the Constitution the same way that anti-abortion statutes do.
“People,” Tucker said, “have basic rights over their lives and bodies.”
Their Terms for Helping
Under the self-imposed guidelines, Compassion in Dying offers suicide counseling and support only to individuals in sound mental condition and have less than six months to live. Certain diseases tend to fall under the guidelines and others do not. Here is a sample comparison.
QUALIFY FOR COUNSELING
Diseases where doctors typically can attest that death is immeninent within six months and where the victim often remains in sound mental condition: Annual U.S. deaths Cancer*: 514,657 AIDS: 29,555 Emphysema: 16,436 *
DON’T QUALIFY FOR COUNSELING
Diseases where imminent death cannot be certified or where mental soundness is usually questioned:
Annual U.S. deaths Heart disease: 720,862 Alzheimer’s disease: 14,112 Multiple sclerosis: 1,808 Sources: Compassion in Dying, National Center for Health Statistics; death rates are for 1991