Rx For Death

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As the most prominent "obitiatrist," which is what he would like to call death specialists, Kevorkian has been outspoken about his safeguards. "You act only after it is absolutely justifiable," he insists. "The patient must be mentally competent, the disease incurable." The trouble is that he has trouble meeting his own standards. Over the years, when he has called the doctors and psychiatrists of the people he was working with, they have said they would have nothing to do with him. "Now that's ethical?" he asks. "If doctors won't cooperate, what do you expect me to do? You think I'm going to let the patient suffer because they don't consult?"

But if his adversaries are right, one recent case shreds Kevorkian's safety net. In February, Kevorkian assisted in the suicide of Hugh Gale, 70, an emphysema patient who may, at the last minute, have changed his mind. ^ According to one version of the report that Kevorkian wrote, about 45 seconds after putting on the carbon-monoxide mask, Gale became flushed, agitated, saying "Take it off!" The mask was immediately replaced with oxygen, which helped calm him down. "The patient wanted to continue," the report states. "After about 20 minutes, with nasal oxygen continuing, the mask was replaced over his nose and mouth, and he again pulled the clip off the crimped tubing. In about 30 to 35 seconds he again flushed, became agitated with moderate hyperpnea ((rapid or deep breathing)); and immediately after saying "Take it off!" once again, he fell into unconsciousness. The mask was then left in place . . . Heartbeat was undetectable about 3 minutes after last breath." Kevorkian's lawyer says the report was an erroneous draft. The prosecutor declined to press murder charges.

In fact, by his own, self-imposed rules, Kevorkian may have gone too far. In an article in the American Journal of Forensic Psychiatry last year, Kevorkian sketched a hypothetical example of how a patient, "Wanda Endittal," and her doctors, "Will B. Reddy," "Frieda Blaime" and "Dewey Ledder" should proceed before a suicide: "If in any of her reviews, Wanda manifests any degree of ambivalence, hesitancy or outright doubt with regard to her original decision, the entire process is stopped immediately and Wanda is no longer -- and can never again be -- a candidate for medicide in the state of Michigan."

Kevorkian's opponents also charge that without safeguards and consultations and thorough psychiatric evaluations, patients may seek out suicide not because of their disease, but because of their despair. Recognizing depression in dying patients is hard, since the culture ties the two together. Its symptoms of fatigue, loss of appetite, aches and pains mimic those of advanced cancer. "What Kevorkian's doing is killing people because they're depressed," says James Bopp Jr., an Indiana attorney who is president of the National Legal Center for the Medically Dependent and Disabled. "But depression is curable. He takes absolutely no account of this. He's not qualified to diagnose depression nor is he qualified to treat it."

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