Recently it was announced that Dr. Jack Kevorkian (also known as Dr. Death) died — ironically, not by suicide.
As a psychiatrist, one of the things I consider part of my job description is suicide prevention. Although many consider Dr. Kevorkian a civil rights activist for assisted suicide, I believe that there was a severe lack of ethics in his medical practice.
From everything I’ve read in the media (and I do acknowledge that this information is not as complete as the information presented at his three criminal trials), there is a lot of controversy about how he proceeded to do his work. There are reports that he did not perform full psychiatric screenings to assess for depression or other treatable mental illnesses; that a significant number of patients did not in fact have terminal illnesses; that a few patients did not present with any physical problems whatsoever at autopsy; and that death for some patients came within 24 hours of meeting with with Dr. Kevorkian for a consultation.
There are also reports that Dr. Kevorkian was interested in the very scientific process of vivisection. Finally, Dr. Kevorkian was not an internist, or oncologist, or psychiatrist. He was a pathologist, practicing in the one area in medicine that requires the least amount of patient care, in fact functioning more as a scientist in a lab rather than a clinical physician. It’s all a little frightening, what he claimed he did, which was assist over 130 patients in suicide with a machine that he created to inject the medications.
The area of assisted suicide is certainly controversial, and the culture of health care has trended to one of “do whatever it takes” to keep someone alive. A significant amount of health care dollars are spent on the last year, and the last month of a patient’s life, and most of that money is spent in an effort to keep the patient alive. For some, by the time it comes to make a decision about CPR and other end-of-life saving measures, the decision must be made by the family because the patient is no longer able to do so. This is the other extreme of how to manage terminal issues, and this end of the spectrum is just as unfortunate.
Patients should not have to suffer through the last months of their lives, but assisted suicide, as it stands now, may not be the best option either. While it is difficult for physicians to bring these issues up with patients prematurely, this is often the one saving grace in difficult situations and this also helps families and patients manage these difficult issues with some guidance, whatever their decisions may be.
Christina Girgis is a psychiatrist who blogs at getaheadwithdrg.
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