Rx For Death

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Worse, he says, doctors ignore their patient's suffering. "Up to 90% of patients die in too much pain. Some doctors actually argue that their patients ) are going to get addicted. But they can't have thought about it for more than two minutes to say something like that. The vast majority simply don't know how to treat pain, and they don't think it's important. They want to cure the person. Death is still seen as the enemy. And that's what Kevorkian throws in their face. What he says is, 'Some people want death, and I am going to give it to them.' "

Finally, Annas says, "we more or less abandon dying patients. When there is nothing more medicine can offer, we turn them over to the nursing staff, and we don't see them anymore."

Faced with such prospects, is it any wonder Kevorkian has hundreds of letters from people who want him to help them die?

When people are asked how they wish to die, most respond something like this: quickly, painlessly, at home, surrounded by family and friends. Ask them how they expect to die, and the fear emerges: in the hospital, all alone, on a machine, in pain. What Kevorkian claims to offer patients is a chance to control the circumstances of their death -- something which, for all the new laws and heightened awareness of recent years, many hospitals and doctors still may fail to do.

Kevorkian knows firsthand about loss of control. "Our mother suffered from cancer," says his sister Margo Janus. "I saw the ravages right up to the end. Her mind was sound, but her body was gone. My brother's option would have been more moral than all the Demerol that they poured into her, to the point that her body was all black and blue from the needle marks. She was in a coma, and she weighed only 70 lbs. Even then I said to the doctor, 'This isn't right, to keep her on IV,' but he shrugged his shoulder and said, 'I'm bound by my oath to do that.' "

When the Supreme Court ruled in 1990 that Nancy Cruzan's parents could remove the feeding tube that was keeping their comatose daughter alive, the Justices affirmed the growing belief that there was no virtue in heroically prolonging life against a patient's wishes. Since then, doctors have invented guidelines, ethicists have organized seminars, and Congress has passed the Patient Self-Determination Act, requiring hospitals to tell people about their right to control their treatment through living wills and powers of attorney. And yet every day in hospitals across the country, patients and their families are learning that, for all the new legal options and heightened awareness, once inside a hospital, there is virtually nothing a patient or a family can do to make dying simple.

When Susan Evans of the University of Pennsylvania's Annenberg School for Communication held focus groups about living wills, she uncovered a deep mistrust between doctors and patients around the subject of dying. Doctors think patients don't want to talk about it; patients think doctors lack the time and training to do so. Some are cynical about doctors' motives. "The longer I am on a machine," one patient said, "the more money they make."

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