Life and Death and Dying and the Journey with Dr. Death

"A doctor in America is killing his patients" is all what I remember from watching the news on Jordan TV sometime in the early 1990s. It was a horror story. The doctor's name was Dr. Kevorkian but he was called Dr. Death.

As I finished medical school and moved to the US for training, I had an attending physician (supervisor) who liked to joke with his patients introducing himself to them with, "Hello, my name is Dr. Kevorkian, I will be your doctor" just to get a good laugh. Needless to say, Kevorkian has become synonym with death.

Death has become part of my daily life since I decided to become a doctor. I remember my first patient who died, the first corpse I saw in anatomy class, the first freshly-dead body dissected in the forensic medicine course. It wasn't scary at all even for the most fainted-hearted among us in medical school. We all knew that one day we will become cold dead bodies. I always said I'd rather sleep in the morgue among dozens of dead people than sleep alone in my room with a mosquito above my head.

Death is a peaceful end to an often less peaceful life. I can deal with it. But dying is torture, and very few know how to deal with it.

There is a group of patients who don't die once; they experience dying, or in other words, they die every day. Those are the chronically ill patients, and every doctor has seen a few hundreds of them. I almost see one every single day. I know most of their names, where they live, if they have a car or not, even what their kids do for a living. Even in my mind I can recall the surgeries and medications that each one had and even remember their lab tests from many months back. These guys spend more time seeing doctors and doing tests than in their house. Their daily struggle is to remain alive. Their quality of life however is awful, but stable. Awfully stable. It's not going to improve and all what doctors do is slow their death, or prolong it, depending on the way you look at it.

For some of these guys, Dr. Kevorkian was the answer. They asked for him. He didn't contact these patients, but they contacted him. It's illegal for you to kill yourself in most countries in the world, including the US. These patients asked Kevorkian to do it for them in a painless and quick way. Kevorkian assessed them and selectively helped them end their lives. He videotaped every patient to make sure they voluntarily requested the death. He wasn't paid for any of these procedures.

Kevorkian had to stand trial for many of these murders as they've been illegal. The families of the patients stood and defended him and the decision that their loved ones had made. Kevorkian was acquitted all the time until a prosecutor played a legal trick and was able to find Kevorkian guilty of murder. He spent 8 years in jail.

One thing I learned, is that people change their minds when they get sick. How many times have you heard one say, "If I get cancer, I don't want to get chemo, just let me die in peace" ? Let me tell you something: don't believe them. If they get cancer, they'll get chemo, and radiation, and surgery, and a lot of pills, and herbs, and experimental treatments, and prayers and creams and lotions and Chinese remedies and whatever your grandmother used to treat food poisoning. They'll use it all to stay alive. Some survive, some do not, and some decide to give up even before their time is over.

Likewise, I don't know how will these people react when that moment arrives; the moment when they surrender, when they declare that they've had enough. We don't know how some of the people closest to us will react in these situations. I don't even know how I myself will react when this moment comes. But I know that everyone deserves to have all options available to them, and one of these options is euthanasia, or physician-assisted suicide.

It's horrifying for some to think about it, and for those very uncomfortable with it (and I'm one of them) I say , don't do it. Just don't prevent others mentally-stable adults from considering it. Most, if not all, of those 130 people that Kevorkian ended their lives did not want to die had they been healthy or even ill but with a reasonable quality of life. But when they got very ill, and they changed their mind.

There are many things that Dr. Kevorkian could have done differently. He didn't obtain a psychiatric consultation on all patients. He didn't fully assess the medical condition of each one. It's argued that some of his patients may even had reversible medical illnesses. However, the conditions in which he worked have been very imperfect, and he himself acknowledged that. He opened a debate on a topic that is very hard to talk about and is very controversial in its own.

Just like people have different perspectives of what life means, they differ on the way they think it should end. But I hope we'll agree that every one must have a complete control on his own life. We do end lives of criminals convicted of serious crimes. We do end lives of enemy soldiers in wars and sometimes even celebrate it. However we are not honoring the wish of a suffering person from ending his/her own life even if they request to, and we decide for them to have it end in pain and emotional suffering against their will rather than peace and comfort. Dr. Kevorkian, who passed away last month, said that he was serving his patients and honoring their will. By no means was he Dr. Death, as he appreciated exactly what the value of life and what it means to be living. RIP, Dr. Kevorkian, Dr. Life.

"When your conscience says law is immoral, don't follow it. If you don't have liberty and self-determination, you've got nothing, that's what this is what this country is built on. And this is the ultimate self-determination, when you determine how and when you're going to die when you're suffering. The patient's autonomy always, always should be respected, even if it is absolutely contrary to best medical advice and what the physician wants." Jack Kevorkian, during his trials.

Suggested Movie: You Don't Know Jack, by Al Pacino.