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David Kessler

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Paging Dr. Kevorkian

Posted: 06/01/07 11:06 AM ET

Kevorkian's release is not the answer; better end-of-life care is the prescription needed.

Kevorkian is being released from prison this June. Even though he says he won't break the law when he is released, you have to wonder what effect his release will have, if any, on the assisted suicide debate. When the measure comes up it has been defeated in every state except one, Oregon. California is now once again proposing a new assisted suicide law.

Kevorkian, like no other, raised the issue and started the debate. My stance on this issue is complex, but then again, whose isn't? I know I may be in the minority here, that I'm against assisted suicide. From my hospice perspective, I don't believe that if you're getting poor pain management or inadequate end-of-life care, in a civilized society, suicide should be your best option for a good death. What I hope Kevorkian's release, if picked up by the media, will be is once again a wake-up call to the medical community that we are not helping people die a good, comfortable, death.

While of course, if you look back at medical history, this has always happened under the radar and probably always will. So I do understand the argument of why not regulate it and make it safe; but, I also remember whenever we haven't been able to achieve something such as when we couldn't go to the moon, we didn't say -- well, we can't do it so let's just blow it up. Or, before we could successfully do heart or kidney transplants we never said not let's keep trying; let's just let them slip away quietly. Our answer should never be, if we can't improve care -- let's find a way to help them die quicker.

Unfortunately, there is plenty of room for improvement in end-of-life care. One study found that 56% of our dying had moderate to severe pain. We would never accept that percentage from our cable or Internet providers if they didn't provide services 56 percent of the time; yet, we accept poor end-of-life care so often because it is a subject that we are uncomfortable dealing with until we are faced with it ourselves.

As I lecture across the country, assisted suicide always comes up and I remember always looking forward to going to Oregon to talk to those who passed our only law. What they have told me is that America doesn't really understand them. They explained they are not pro-suicide, they are and I quote "second and third generation Oregonians and they don't believe anyone, least of all our government, can come in and tell them when and where they can and can't die." So it is with mixed emotions that I think about Kevorkian's release; that I too don't believe anyone should tell us what kind of deaths we should be able to have. My 25 years of hospice and palliative care tells me assisted suicide is not the answer and while Kevorkian has his machine, good pain management is not rocket science and we can do it.

I am aware that in Oregon where a physician-assisted suicide law has passed, there have been relatively few people that have used the process and that the side effect has been better end- of-life care. I still firmly believe we can get better end-of-life care without legalizing suicide. The huge elephant in the room that sits behind this debate is how can we, in good faith, come up with allowing assisted suicide as a quiet legal way to slip out of our healthcare system using medication when we have a healthcare system that doesn't let people in yet! We haven't addressed good health care for all, how to improve access to hospice care; how to grow palliative care programs and to fund them in our hospitals to provide good pain management.

Of course, many people always site those few cases where pain might not be able to be managed despite our best efforts. Even then we have measures to handle intractable pain such as palliative sedation -- the same way we can sedate someone for an operation we can sedate them temporarily in those very rare cases.

Welcome back to free society, Jack Kevorkian. Call me old-fashioned -- I just believe in killing the pain, not the patient.

 
 
 

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